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NPI Code Detail

MEDICARE: MRS. MARLO RUTH LAWRENCE PA-C

MEDICARE: MRS. MARLO RUTH LAWRENCE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA 9104696FL
2363AM0700XMedical Physician AssistantPA09022TX

General Provider Information

NPI Number : 1508007287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARLO RUTH LAWRENCE PA-C
Provider Business Mailing Address
First Line : 12934 WESTELLA DR
Second Line :
City : HOUSTON
State : TX
Zip : 77077-3704
Country : US
Telephone Number : 786-853-9037
Fax Number :
Provider Business Practice Location Address
First Line : 9329 KATY FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77024-1512
Country : US
Telephone Number : 786-853-9037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2009
Last Update Date : 09/10/2014

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