Healthcare Provider Details

I. General information

NPI: 1508869587
Provider Name (Legal Business Name): JOHN M LAWTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RIVERSIDE DR SUITE 200
GREEN BAY WI
54301-2300
US

IV. Provider business mailing address

2020 RIVERSIDE DR SUITE 200
GREEN BAY WI
54301-2300
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-9920
  • Fax: 920-433-9927
Mailing address:
  • Phone: 920-433-9920
  • Fax: 920-433-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25976
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: