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General NPI Number Information
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NPI Number | 1891780904
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Entity Type | Individual
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Provider Name | LAWRENCE JEFFREY RISSMAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 1212 PLEASANT ST STE LL3
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City | DES MOINES
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State | IA
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Zip | 50309-1414
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Country | US
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Telephone | 515-241-8861
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Fax | 515-241-8855
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Provider Business Mailing Address
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Address Line | 1212 PLEASANT ST STE LL3
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City | DES MOINES
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State | IA
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Zip | 50309-1414
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Country | US
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Telephone | 515-241-8861
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Fax | 515-241-8855
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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 | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | 21307
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License Number State | IA
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