MEDICARE: DR. RICHARD B LAWRENCE III 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	MDE2671	TX

General Provider Information

NPI Number	:	1902826688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD B LAWRENCE III M.D.

Provider Business Mailing Address
First Line	:	6457 DARWOOD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4406
Country	:	US
Telephone Number	:	817-994-0235
Fax Number	:	817-377-2958

Provider Business Practice Location Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	SUITE 600
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	214-750-6110
Fax Number	:	214-750-5665

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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