Healthcare Provider Details

I. General information

NPI: 1275693343
Provider Name (Legal Business Name): LAWRENCE LAVINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9424 VETERANS DRIVE SW
LAKEWOOD WA
98498-1163
US

IV. Provider business mailing address

9424 VETERANS DRIVE SW
LAKEWOOD WA
98498-1163
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-4625
  • Fax: 253-581-6329
Mailing address:
  • Phone: 253-589-4625
  • Fax: 253-581-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOP00001467
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberOP00001467
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: