Healthcare Provider Details

I. General information

NPI: 1740399450
Provider Name (Legal Business Name): LAWRENCE HILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 461 BOX 50
FPO AP
96521
CN

IV. Provider business mailing address

PSC 461 BOX 50
FPO AP
96521
US

V. Phone/Fax

Practice location:
  • Phone: 861065325063
  • Fax:
Mailing address:
  • Phone: 861065325063
  • Fax: 861065326424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA23043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: