Healthcare Provider Details

I. General information

NPI: 1174583975
Provider Name (Legal Business Name): LAWRENCE H MUFSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/01/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SE MONTEREY COMMONS BLVD SUITE 300
STUART FL
34996-3329
US

IV. Provider business mailing address

1001 SE MONTEREY COMMONS BLVD SUITE 300
STUART FL
34996-3329
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-9400
  • Fax: 772-283-3832
Mailing address:
  • Phone: 772-286-9400
  • Fax: 772-283-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME53414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: