Provider Demographics
NPI:1194716837
Name:LAWRENCE, STUART ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:ALAN
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 1:2400 S.W. VERMONT ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1940
Mailing Address - Country:US
Mailing Address - Phone:503-452-0915
Mailing Address - Fax:503-768-9232
Practice Address - Street 1:2400 S.W. VERMONT ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1940
Practice Address - Country:US
Practice Address - Phone:503-452-0915
Practice Address - Fax:503-768-9232
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 9348208000000X
ORMD09348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004861Medicaid