Provider Demographics
NPI:1841306842
Name:LAWLOR, JAMES D (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:LAWLOR
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 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:4800 DEERWOOD CAMPUS PARKWAY
Practice Address - Street 2:BUILDING 300, 1ST FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6498
Practice Address - Country:US
Practice Address - Phone:904-905-5022
Practice Address - Fax:904-905-5044
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279647300Medicaid
FLP01366460OtherRAILROAD MEDICARE
FL279647300Medicaid
FLD57744Medicare UPIN
FLD57744Medicare UPIN