MEDICARE: DR. LAWRENCE M MODEL M.D.

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	207Q00000X	Family Medicine Physician	135753	NY
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	ME137239	FL
3	207Q00000X	Family Medicine Physician	ME137239	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184621054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE M MODEL M.D.

Provider Business Mailing Address
First Line	:	10847 THOMAS LAKE MNR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4937
Country	:	US
Telephone Number	:	845-598-3334
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4637
Country	:	US
Telephone Number	:	866-300-6955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	08/22/2019

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