Healthcare Provider Details

I. General information

NPI: 1346354545
Provider Name (Legal Business Name): GEOFFREY LAWRENCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9750
US

IV. Provider business mailing address

13970 SE ALDRIDGE RD
HAPPY VALLEY OR
97236-6514
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-6440
  • Fax:
Mailing address:
  • Phone: 503-658-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD11284
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: