MEDICARE: DR. LAWRENCE ANDREW KOENIG 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	207Q00000X	Family Medicine Physician	G35926	CA

General Provider Information

NPI Number	:	1396715314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ANDREW KOENIG MD

Provider Business Mailing Address
First Line	:	PO BOX 28199
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92198-0199
Country	:	US
Telephone Number	:	858-675-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	15611 POMERADO RD
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2437
Country	:	US
Telephone Number	:	858-675-3100
Fax Number	:	858-613-2930

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/09/2007

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