Healthcare Provider Details

I. General information

NPI: 1306133129
Provider Name (Legal Business Name): ANDREW J LAWRENCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S MOUNT AUBURN RD STE 101
CAPE GIRARDEAU MO
63703-4940
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 573-519-4960
  • Fax: 573-519-4655
Mailing address:
  • Phone: 573-519-4960
  • Fax: 573-519-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2015029582
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL33845
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015029582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: