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General NPI Number Information
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NPI Number | 1750511440
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Entity Type | Organization
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Legal Business Name | MARK S LAWLER MD INC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 7100 REDWOOD BLVD SUITE 200
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City | NOVATO
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State | CA
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Zip | 94945-4110
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Country | US
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Telephone | 415-492-1600
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Fax | 415-492-1688
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Provider Business Mailing Address
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Address Line | 7100 REDWOOD BLVD SUITE 200
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City | NOVATO
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State | CA
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Zip | 94945-4110
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Country | US
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Telephone | 415-492-1600
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Fax | 415-492-1688
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. MARK SHANNON LAWLER
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Credential | M.D.
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Telephone | 415-492-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A69218
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License Number State | CA
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