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General NPI Number Information
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NPI Number | 1871685255
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Entity Type | Organization
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Legal Business Name | BRUCE LAWRENCE MD PROF CORP
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 445 30TH ST 2ND FLOOR
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City | OAKLAND
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State | CA
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Zip | 94609-3301
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Country | US
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Telephone | 510-465-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 445 30TH ST 2ND FLOOR
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City | OAKLAND
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State | CA
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Zip | 94609-3301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE P LAWRENCE
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Credential | M.D.
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Telephone | 510-465-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | G24736
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License Number State | CA
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