MEDICARE: JOHN C LAWLOR DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3145	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC2795	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1043409501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C LAWLOR DPM PA

Provider Business Mailing Address
First Line	:	8851 BOARDROOM CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4888
Country	:	US
Telephone Number	:	239-481-7000
Fax Number	:	239-481-8150

Provider Business Practice Location Address
First Line	:	1435 SE 8TH TER
Second Line	:	SUITE E
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3289
Country	:	US
Telephone Number	:	239-481-7000
Fax Number	:	239-481-8150

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN C LAWLOR
Credential	:	DPM
Telephone Number	:	239-481-7000

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	02/07/2008

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