Healthcare Provider Details

I. General information

NPI: 1164465258
Provider Name (Legal Business Name): KEAN B LAWLOR, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PL STE 203
SEATTLE WA
98105-4093
US

IV. Provider business mailing address

22833 BOTHELL EVERETT HWY STE 201
BOTHELL WA
98021-9385
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-1168
  • Fax: 206-525-1169
Mailing address:
  • Phone: 425-486-2340
  • Fax: 425-483-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETTY JEAN HEUPEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-486-2340