Provider Demographics
NPI:1225004187
Name:O HOLLERAN, LAWRENCE WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:O HOLLERAN
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 2476
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2476
Mailing Address - Country:US
Mailing Address - Phone:307-637-5600
Mailing Address - Fax:307-637-0249
Practice Address - Street 1:4003 RAWLINS ST STE B
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1800
Practice Address - Country:US
Practice Address - Phone:307-637-5600
Practice Address - Fax:307-637-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26688208600000X
NE16963208600000X
WY6423A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115489300Medicaid
WY115489300Medicaid
D24834Medicare UPIN