Healthcare Provider Details

I. General information

NPI: 1760576409
Provider Name (Legal Business Name): GEORGE W LAWRENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 NORTHWEST AVENUE SUITE 203
BELLINGHAM WA
98226
US

IV. Provider business mailing address

5775 SCHICKLER LANE
BELLINGHAM WA
98226
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-2330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00028177
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier24076
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerREG RYDER
# 2
Identifier107117
Identifier TypeOTHER
Identifier State
Identifier IssuerL&I
# 3
Identifier8186231
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: