Provider Demographics
NPI:1649483769
Name:D'ANTONIO, LAWRENCE PATRICK II (DO)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PATRICK
Last Name:D'ANTONIO
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30386
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-0386
Mailing Address - Country:US
Mailing Address - Phone:520-390-1355
Mailing Address - Fax:
Practice Address - Street 1:2814 N CALLE LADERA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3203
Practice Address - Country:US
Practice Address - Phone:520-390-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC98197Medicare UPIN