Provider Demographics
NPI:1063403848
Name:LAWLOR, BRETT D (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:D
Last Name:LAWLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4335
Mailing Address - Country:US
Mailing Address - Phone:605-721-7246
Mailing Address - Fax:605-341-4501
Practice Address - Street 1:1136 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4335
Practice Address - Country:US
Practice Address - Phone:605-721-7246
Practice Address - Fax:605-341-4501
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4193208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD31783OtherSANDFORD HEALTH PLAN
SD4193OtherDAKOTACARE
SD115322600OtherWYOMING MEDICAID
SD41194500700OtherNEBRASKA MEDICAID
SD1063403848Medicaid
SD0006333OtherWELLMARK BCBS
SD31783OtherSANFORD HEALTH PLAN
SD13327600OtherWYOMING MEDICAID
SD2300560OtherMEDICA
SD250010467Medicare PIN
SD41194500700OtherNEBRASKA MEDICAID
SD1063403848Medicaid