Healthcare Provider Details

I. General information

NPI: 1528033958
Provider Name (Legal Business Name): LAWRENCE A TEPPER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 N ROOSEVELT BLVD
KEY WEST FL
33040-4224
US

IV. Provider business mailing address

21000 PORTOFINO CIR APT 103
PALM BEACH GARDENS FL
33418-1262
US

V. Phone/Fax

Practice location:
  • Phone: 305-296-0021
  • Fax: 561-848-9166
Mailing address:
  • Phone: 561-848-1011
  • Fax: 561-848-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberOS4845
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS4845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: