Healthcare Provider Details

I. General information

NPI: 1417953373
Provider Name (Legal Business Name): JOSEPH J LAWRENCE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SO. BURMA AVE
GILLETTE WY
82716
US

IV. Provider business mailing address

P.O. BOX 638
GILLETTE WY
82717
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-1600
  • Fax: 307-687-7243
Mailing address:
  • Phone: 307-682-3078
  • Fax: 307-687-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5119A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: