Provider Demographics
NPI:1952368839
Name:LAWRENCE, JOHN U (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:U
Last Name:LAWRENCE
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 1:34 S 500 E
Mailing Address - Street 2:STE 202
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1094
Mailing Address - Country:US
Mailing Address - Phone:801-582-2011
Mailing Address - Fax:
Practice Address - Street 1:34 S 500 E
Practice Address - Street 2:STE 202
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-1094
Practice Address - Country:US
Practice Address - Phone:801-582-2011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4803531-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT54605810001Medicaid
UT5748101Medicare ID - Type Unspecified
UT54605810001Medicaid