Healthcare Provider Details

I. General information

NPI: 1841292281
Provider Name (Legal Business Name): LAWRENCE ROBERT MIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 GUZZI LN STE 204
SONORA CA
95370-5288
US

IV. Provider business mailing address

PO BOX 5158
SONORA CA
95370-2158
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5750
  • Fax: 209-536-3516
Mailing address:
  • Phone: 209-352-4129
  • Fax: 209-536-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA40095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: