Provider Demographics
NPI:1982626172
Name:LAWRENCE, ROY F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:F
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 1:1312 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5406
Mailing Address - Country:US
Mailing Address - Phone:731-885-5100
Mailing Address - Fax:731-885-7584
Practice Address - Street 1:1312 BISHOP ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5406
Practice Address - Country:US
Practice Address - Phone:731-885-5100
Practice Address - Fax:731-885-7584
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3171917Medicare ID - Type UnspecifiedMEDICARE NUMBER
TNB03496Medicare UPIN