Healthcare Provider Details

I. General information

NPI: 1083689277
Provider Name (Legal Business Name): LAWRENCE EDWARD TAMBURINO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SERVICE DR
BRANDON MS
39042-2401
US

IV. Provider business mailing address

103 SERVICE DR
BRANDON MS
39042-2401
US

V. Phone/Fax

Practice location:
  • Phone: 601-824-4700
  • Fax: 601-824-4800
Mailing address:
  • Phone: 601-824-4700
  • Fax: 601-824-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number80160
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: