Provider Demographics
NPI:1407854631
Name:EHRLICH, LAWRENCE MATHEW (DO)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MATHEW
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5492
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5492
Mailing Address - Country:US
Mailing Address - Phone:714-532-5353
Mailing Address - Fax:714-532-5053
Practice Address - Street 1:1040 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2111
Practice Address - Country:US
Practice Address - Phone:714-532-5353
Practice Address - Fax:714-532-5353
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02960Medicare UPIN
20A6412Medicare ID - Type Unspecified