Provider Demographics
NPI:1679534432
Name:CONWAY, LARS THOMAS (MD)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:THOMAS
Last Name:CONWAY
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 3405
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3405
Mailing Address - Country:US
Mailing Address - Phone:509-892-2700
Mailing Address - Fax:509-892-2740
Practice Address - Street 1:13103 E MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1642
Practice Address - Country:US
Practice Address - Phone:509-892-2700
Practice Address - Fax:509-892-2740
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-118222207ZC0500X, 207ZP0102X
IDM-12068207ZP0102X, 207ZC0500X
WAMD60314310207ZC0500X, 207ZP0102X
AK165109207ZC0500X, 207ZP0102X
WY9164A207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN936780200Medicaid
MN03069C0OtherBCBS
MN220007425OtherRR MEDICARE
MN03069C0OtherBCBS
MN220000045Medicare ID - Type Unspecified