Provider Demographics
NPI:1649352618
Name:LAWRENCE, ROBERT T (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 DOLLY VARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1904
Mailing Address - Country:US
Mailing Address - Phone:907-304-3301
Mailing Address - Fax:
Practice Address - Street 1:550 W 7TH AVE STE 1800
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3569
Practice Address - Country:US
Practice Address - Phone:907-304-3301
Practice Address - Fax:907-269-7310
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK5807OtherLICENSED PHYSICIAN