Healthcare Provider Details

I. General information

NPI: 1619087491
Provider Name (Legal Business Name): DR PETER LAWRASON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST SUITE 101
FAIRBANKS AK
99701-5930
US

IV. Provider business mailing address

1919 LATHROP ST SUITE 101
FAIRBANKS AK
99701-5930
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-1622
  • Fax: 907-452-1664
Mailing address:
  • Phone: 907-452-1622
  • Fax: 907-452-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberAA2385
License Number StateAK

VIII. Authorized Official

Name: PETER D LAWRASON
Title or Position: OWNER
Credential: MD
Phone: 907-452-1622