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NPI Code Detail

MEDICARE: DR. LAWRENCE DAVID BRODER MD

MEDICARE: DR. LAWRENCE DAVID BRODER 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
1207Q00000XFamily Medicine PhysicianL2154TX

General Provider Information

NPI Number : 1467468736
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE DAVID BRODER MD
Provider Business Mailing Address
First Line : 1106 CLAYTON LN STE 102W
Second Line :
City : AUSTIN
State : TX
Zip : 78723-2433
Country : US
Telephone Number : 512-872-6868
Fax Number :
Provider Business Practice Location Address
First Line : 1106 CLAYTON LN STE 102W
Second Line :
City : AUSTIN
State : TX
Zip : 78723-2433
Country : US
Telephone Number : 512-872-6868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 05/20/2025

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Directions to “ DR. LAWRENCE DAVID BRODER MD” Practice Location

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