MEDICARE: COURTNEY N LAWRENCE M.D.

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	208000000X	Pediatrics Physician	J0059	TX

General Provider Information

NPI Number	:	1861494957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY N LAWRENCE M.D.

Provider Business Mailing Address
First Line	:	1954 E HOUSTON ST
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-2951
Country	:	US
Telephone Number	:	210-576-0533
Fax Number	:	210-266-4676

Provider Business Practice Location Address
First Line	:	4212 E SOUTHCROSS BLVD
Second Line	:	STE 150
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3783
Country	:	US
Telephone Number	:	210-337-2100
Fax Number	:	210-337-2242

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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Directions to “ COURTNEY N LAWRENCE M.D.” Practice Location

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