Provider Demographics
NPI:1841292281
Name:MIER, LAWRENCE ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:MIER
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:PO BOX 5158
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-2158
Mailing Address - Country:US
Mailing Address - Phone:209-352-4129
Mailing Address - Fax:209-536-3516
Practice Address - Street 1:680 GUZZI LN
Practice Address - Street 2:STE 204
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5288
Practice Address - Country:US
Practice Address - Phone:209-536-5750
Practice Address - Fax:209-536-3516
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A400950Medicaid
CA00A400950Medicaid
A85380Medicare UPIN