Healthcare Provider Details

I. General information

NPI: 1982799821
Provider Name (Legal Business Name): HEALY WEST LAWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3809 COMPUTER DR STE 100
RALEIGH NC
27609-6518
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-5332
  • Fax:
Mailing address:
  • Phone: 919-781-9078
  • Fax: 919-719-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39967
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: