Healthcare Provider Details

I. General information

NPI: 1033187158
Provider Name (Legal Business Name): ROBERT D LAWRENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 W MARCH LN SUITE 179E
STOCKTON CA
95207-6652
US

IV. Provider business mailing address

PO BOX 77800
STOCKTON CA
95267-1100
US

V. Phone/Fax

Practice location:
  • Phone: 209-477-4432
  • Fax: 209-320-6136
Mailing address:
  • Phone: 209-477-4432
  • Fax: 209-320-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA22667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: