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General NPI Number Information
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NPI Number | 1104896794
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Entity Type | Individual
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Provider Name | BRIAN DOUGLAS LAWENDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 8026 S TAMIAMI TRAIL
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City | VENICE
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State | FL
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Zip | 34293
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Country | US
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Telephone | 941-220-6460
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Fax | 941-220-5284
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Provider Business Mailing Address
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Address Line | 3080 HARBOR BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6720
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Country | US
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Telephone | 941-883-2199
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Fax | 941-979-5041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A87177
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 13433
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD60622589
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME167833
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License Number State | FL
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