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General NPI Number Information
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NPI Number | 1689938656
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Entity Type | Individual
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Provider Name | LAWRENCE CHRISTOPHER CONOVER PAC
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Gender | Male
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 1698 E MCANDREWS RD STE 400
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City | MEDFORD
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State | OR
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Zip | 97504-5590
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Country | US
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Telephone | 541-732-6000
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Fax | 541-732-6005
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone | 541-732-6000
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Fax | 541-732-6005
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10003269
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA172028
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License Number State | OR
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