Provider Demographics
NPI:1588717516
Name:LAWSON, KENNETH LEE (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LEE
Last Name:LAWSON
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 1:385 RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467
Mailing Address - Country:US
Mailing Address - Phone:541-271-2119
Mailing Address - Fax:541-271-6344
Practice Address - Street 1:385 RANCH ROAD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467
Practice Address - Country:US
Practice Address - Phone:541-271-2119
Practice Address - Fax:541-271-6344
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18026208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR046404Medicaid
OR046404Medicaid
115169Medicare PIN