Provider Demographics
NPI:1154344810
Name:LAWRENCE, BILL BROOKS (MD)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:BROOKS
Last Name:LAWRENCE
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:PO BOX 10581
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0009
Mailing Address - Country:US
Mailing Address - Phone:501-327-6900
Mailing Address - Fax:501-327-3690
Practice Address - Street 1:3650 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7272
Practice Address - Country:US
Practice Address - Phone:501-327-6900
Practice Address - Fax:501-327-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0722160002OtherCIGNA
AR5K059OtherBCBS
AR129591001Medicaid
AR710790635OtherTRICARE
AR5K059OtherHEALTHADVANTAGE
ARFP98253OtherUNITED HEALTHCARE
AR16918000000OtherQUALCHOICE
AR080072893OtherRAILROAD MEDICARE
AR7464032OtherAETNA
AR392651OtherHEALTHLINK
AR5K059OtherHEALTHADVANTAGE
AR129591001Medicaid