MEDICARE: ANDREW J LAWRENCE MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	2015029582	MO
2	207Q00000X	Family Medicine Physician	LL33845	SC
3	207Q00000X	Family Medicine Physician	2015029582	MO

General Provider Information

NPI Number	:	1306133129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J LAWRENCE MD

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	573-519-4960
Fax Number	:	573-519-4655

Provider Business Practice Location Address
First Line	:	650 S MOUNT AUBURN RD STE 101
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4940
Country	:	US
Telephone Number	:	573-519-4960
Fax Number	:	573-519-4655

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	03/17/2026

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