Healthcare Provider Details

I. General information

NPI: 1811097108
Provider Name (Legal Business Name): LAWRENCE TYE WESTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 GROVE ROAD
GREENVILLE SC
29605-4211
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-1400
  • Fax: 864-522-1429
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number22651
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: