Healthcare Provider Details

I. General information

NPI: 1932142585
Provider Name (Legal Business Name): LAWRENCE J FLEENOR JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOLTON AVE E
BIG STONE GAP VA
24219-3350
US

IV. Provider business mailing address

PO BOX K
BIG STONE GAP VA
24219-0260
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-1600
  • Fax: 276-523-5308
Mailing address:
  • Phone: 276-523-1600
  • Fax: 276-523-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101017923
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: