Healthcare Provider Details

I. General information

NPI: 1225004187
Provider Name (Legal Business Name): LAWRENCE WILLIAM O HOLLERAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 RAWLINS ST STE B
CHEYENNE WY
82001-1800
US

IV. Provider business mailing address

PO BOX 2476
CHEYENNE WY
82003-2476
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-5600
  • Fax: 307-637-0249
Mailing address:
  • Phone: 307-637-5600
  • Fax: 307-637-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26688
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16963
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6423A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: