Healthcare Provider Details

I. General information

NPI: 1124052782
Provider Name (Legal Business Name): LAWRENCE GORDON STRATE M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST
PAYNESVILLE MN
56362-1445
US

IV. Provider business mailing address

18505 210TH AVE NE
PAYNESVILLE MN
56362-9448
US

V. Phone/Fax

Practice location:
  • Phone: 320-243-3763
  • Fax: 320-243-3174
Mailing address:
  • Phone: 320-276-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43062
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: