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General NPI Number Information
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NPI Number | 1255955191
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Entity Type | Organization
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Legal Business Name | KENNETH G. LAWLOR, DO, PLLC
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Dates
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Enumeration Date | 06/06/2020
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Last Update Date | 06/06/2020
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Provider Practice Location Address
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Address Line | 2060 W WHISPERING WIND DR STE 264
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City | PHOENIX
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State | AZ
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Zip | 85085-2869
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Country | US
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Telephone | 623-235-6889
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Fax | 623-235-6877
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Provider Business Mailing Address
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Address Line | 3108 CLEARWATER DR STE A
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City | PRESCOTT
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State | AZ
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Zip | 86305-7170
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Country | US
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Telephone | 928-717-8838
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH GAYLE LAWLOR
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Credential | DO
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Telephone | 928-717-8838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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