MEDICARE: DR. LAWRENCE RUSSELL CANFIELD 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	207Q00000X	Family Medicine Physician	98-233	NM
2	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	98-233	NM
3	207ZI0100X	Immunopathology Physician	98-233	NM
4	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	98-233	NM

General Provider Information

NPI Number	:	1922217124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE RUSSELL CANFIELD M.D.

Provider Business Mailing Address
First Line	:	66 AVENIDA ALDEA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-9449
Country	:	US
Telephone Number	:	505-795-7111
Fax Number	:	505-795-7112

Provider Business Practice Location Address
First Line	:	66 AVENIDA ALDEA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-9449
Country	:	US
Telephone Number	:	505-795-7111
Fax Number	:	505-795-7112

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/19/2016

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