Healthcare Provider Details

I. General information

NPI: 1194827949
Provider Name (Legal Business Name): JEFFREY DAVID LAWRENCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LAKE OTIS PKWY SUITE 100
ANCHORAGE AK
99508-5200
US

IV. Provider business mailing address

4001 LAKE OTIS PKWY SUITE 100
ANCHORAGE AK
99508-5200
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-7757
  • Fax: 907-561-7767
Mailing address:
  • Phone: 907-561-7757
  • Fax: 907-561-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberAA1970
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberAA1970
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: