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General NPI Number Information
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NPI Number | 1619955457
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Entity Type | Individual
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Provider Name | LAWRENCE WILLIAM GESS JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 2364 HIGHWAY 287 N SUITE 115
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City | MANSFIELD
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State | TX
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Zip | 76063-9208
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Country | US
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Telephone | 817-539-2214
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Fax | 817-539-2254
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Provider Business Mailing Address
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Address Line | 5300 STARRY CT
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City | FORT WORTH
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State | TX
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Zip | 76123-1956
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Country | US
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Telephone | 817-294-2504
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00012
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License Number State | TX
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