Provider Demographics
NPI:1780616870
Name:FROST, LAWRENCE JOSEPH (PA-C)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:FROST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:WINTERHAVEN
Mailing Address - State:CA
Mailing Address - Zip Code:92283-0788
Mailing Address - Country:US
Mailing Address - Phone:760-538-3073
Mailing Address - Fax:760-205-0016
Practice Address - Street 1:2133 WINTERHAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283-0788
Practice Address - Country:US
Practice Address - Phone:760-538-3073
Practice Address - Fax:760-205-0016
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5160363A00000X
AZ3282363AS0400X
CA55434363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ28416Medicare UPIN