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General NPI Number Information
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NPI Number | 1497055115
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Entity Type | Organization
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Legal Business Name | BRUCE R. LAWRENCE, D.P.M., INC.
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 2119 S EL CAMINO REAL
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City | OCEANSIDE
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State | CA
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Zip | 92054-6202
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Country | US
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Telephone | 760-757-3070
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Fax | 760-757-7139
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Provider Business Mailing Address
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Address Line | 2119 S EL CAMINO REAL
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City | OCEANSIDE
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State | CA
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Zip | 92054-6202
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Country | US
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Telephone | 760-757-3070
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Fax | 760-757-7139
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE R. LAWRENCE
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Credential | D.P.M.
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Telephone | 760-757-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E-1273
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License Number State | CA
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