Healthcare Provider Details

I. General information

NPI: 1174550313
Provider Name (Legal Business Name): JAMES DALE LAWRENZI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 NW 1621ST RD
BATES CITY MO
64011-8395
US

IV. Provider business mailing address

793 NW 1621ST RD
BATES CITY MO
64011-8395
US

V. Phone/Fax

Practice location:
  • Phone: 816-226-1182
  • Fax: 816-466-8821
Mailing address:
  • Phone: 816-226-1182
  • Fax: 844-384-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-38315
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008021948
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: