MEDICARE: ERIC U.T. LAWRENCE D.P.M.

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	213ES0131X	Foot Surgery Podiatrist	E4288	CA

General Provider Information

NPI Number	:	1497754915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC U.T. LAWRENCE D.P.M.

Provider Business Mailing Address
First Line	:	19840 ACRE ST
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19840 ACRE ST
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3301
Country	:	US
Telephone Number	:	818-993-8847
Fax Number	:

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/19/2018

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