Provider Demographics
NPI:1932149663
Name:VOESACK, LAWRENCE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:VOESACK
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 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-1963
Mailing Address - Fax:432-640-1875
Practice Address - Street 1:3001 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7129
Practice Address - Country:US
Practice Address - Phone:432-580-5966
Practice Address - Fax:432-580-7413
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7408207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124591211Medicaid
TX124591211Medicaid