Healthcare Provider Details

I. General information

NPI: 1396999868
Provider Name (Legal Business Name): CYNTHIA JEAN LAWLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 E 3900 S STE G200
SALT LAKE CITY UT
84124-1224
US

IV. Provider business mailing address

PO BOX 742382
ATLANTA GA
30374-2382
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-7766
  • Fax: 801-270-3395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number7151996-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: