Provider Demographics
NPI:1124052782
Name:STRATE, LAWRENCE GORDON (MD,)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GORDON
Last Name:STRATE
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18505 210TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-9448
Mailing Address - Country:US
Mailing Address - Phone:320-276-8209
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1445
Practice Address - Country:US
Practice Address - Phone:320-243-3763
Practice Address - Fax:320-243-3174
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN968182500Medicaid
MN968182500Medicaid
MN080008970Medicare ID - Type Unspecified
MNH16870Medicare UPIN