Healthcare Provider Details

I. General information

NPI: 1265599591
Provider Name (Legal Business Name): LAWRENCE PAUL LANDWEHR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 A. EAST RUSSELL AVENUE SUITE 3
WARRENSBURG MO
64093
US

IV. Provider business mailing address

407 A EAST RUSSELL AVENUE SUITE 3
WARRENSBURG MO
64093-2958
US

V. Phone/Fax

Practice location:
  • Phone: 660-422-7000
  • Fax: 660-747-0409
Mailing address:
  • Phone: 660-422-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD111733
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: