MEDICARE: MR. MATTHEW LAWSON PA-C

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	363AM0700X	Medical Physician Assistant	PA 696	KY

General Provider Information

NPI Number	:	1235212994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW LAWSON PA-C

Provider Business Mailing Address
First Line	:	329 DARENIA LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-8635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 EASTERN BYP
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2751
Country	:	US
Telephone Number	:	859-625-3290
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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