Healthcare Provider Details

I. General information

NPI: 1437132727
Provider Name (Legal Business Name): LAWRENCE H. NEWMAN, M.D., A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 OAK PARK BLVD
PISMO BEACH CA
93449-3292
US

IV. Provider business mailing address

877 OAK PARK BLVD
PISMO BEACH CA
93449-3292
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-8450
  • Fax: 805-474-8454
Mailing address:
  • Phone: 805-474-8450
  • Fax: 805-474-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number980659
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number980659
License Number StateCA

VIII. Authorized Official

Name: DR. LAWRENCE H. NEWMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-474-8450