Provider Demographics
NPI:1811919335
Name:SCHRADER, LAWRENCE F
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:F
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 CORDOVA STATION AVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6316
Mailing Address - Country:US
Mailing Address - Phone:901-465-4300
Mailing Address - Fax:901-465-3357
Practice Address - Street 1:927 CORDOVA STATION AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6316
Practice Address - Country:US
Practice Address - Phone:901-465-4300
Practice Address - Fax:901-465-3357
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28886207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN113800Medicaid
TN3808045Medicare ID - Type Unspecified
TNE28504Medicare UPIN