Healthcare Provider Details

I. General information

NPI: 1538599071
Provider Name (Legal Business Name): WALTER LAWRENCE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 GLOVER AVE
ENTERPRISE AL
36330-2041
US

IV. Provider business mailing address

PO BOX 311991
ENTERPRISE AL
36331-1991
US

V. Phone/Fax

Practice location:
  • Phone: 334-475-2058
  • Fax: 334-489-4308
Mailing address:
  • Phone: 334-475-2058
  • Fax: 334-489-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25503
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number25503
License Number StateAL

VIII. Authorized Official

Name: WALTER J LAWRENCE
Title or Position: MD
Credential:
Phone: 334-475-2058