Provider Demographics
NPI:1952376196
Name:FOLTZ, LAWRENCE EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:FOLTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 SE 15TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9666
Mailing Address - Country:US
Mailing Address - Phone:360-254-4402
Mailing Address - Fax:360-892-9241
Practice Address - Street 1:16500 SE 15TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9666
Practice Address - Country:US
Practice Address - Phone:360-254-4402
Practice Address - Fax:360-892-9241
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP-00001191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1047554Medicaid
WA50D0988185Medicare ID - Type Unspecified
WA1047554Medicaid