Healthcare Provider Details

I. General information

NPI: 1962793844
Provider Name (Legal Business Name): LAWRENCE ALCOCER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST ED DEPT
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3356
  • Fax: 937-208-3356
Mailing address:
  • Phone: 937-208-3356
  • Fax: 937-208-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.120962
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: