Provider Demographics
NPI:1548222938
Name:LAWRENCE, THOMAS L (MD, PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13989
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3989
Mailing Address - Country:US
Mailing Address - Phone:850-942-3937
Mailing Address - Fax:850-942-6279
Practice Address - Street 1:3401 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4425
Practice Address - Country:US
Practice Address - Phone:850-942-3937
Practice Address - Fax:850-942-6279
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64463207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18944OtherBCBS OF FL
FL373454400Medicaid
FLF60747Medicare UPIN
FLF60747Medicare UPIN