Provider Demographics
NPI:1770531691
Name:PELLETIER, LAWRENCE L (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:L
Last Name:PELLETIER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5500 E KELLOGG DR
Mailing Address - Street 2:PRIMARY CARE- ROBERT J DOLE VAMC
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-634-3065
Mailing Address - Fax:316-634-3065
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:PRIMARY CARE- ROBERT J DOLE VAMC
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-634-3065
Practice Address - Fax:316-634-3065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
KS04-14654207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease