Healthcare Provider Details

I. General information

NPI: 1164489548
Provider Name (Legal Business Name): JEFFREY ALAN LAWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/11/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP
JBSA LACKLAND AFB TX
78236
US

IV. Provider business mailing address

WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP
JBSA LACKLAND AFB TX
78236
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-7395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH7320
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: