Provider Demographics
NPI:1366558033
Name:DONOVAN, LAWRENCE T (DO)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:T
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:280 SMITH AVE N STE 500
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2463
Practice Address - Country:US
Practice Address - Phone:651-968-5420
Practice Address - Fax:651-222-0956
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-06-25
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Provider Licenses
StateLicense IDTaxonomies
MN35023207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN200002538Medicare PIN
MN169580100Medicaid
MNP00369239OtherRAILROAD MEDICARE
C78376Medicare UPIN