Provider Demographics
NPI:1699745976
Name:MATHERS, LAWRENCE J (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:MATHERS
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 1:229 HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2902
Mailing Address - Country:US
Mailing Address - Phone:423-623-1057
Mailing Address - Fax:423-625-8620
Practice Address - Street 1:229 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2902
Practice Address - Country:US
Practice Address - Phone:423-623-1057
Practice Address - Fax:423-625-8620
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4070939OtherBLUECARE-NEWPORT
TN4071763OtherBCBST
TN4071787OtherBCBST
TN3886126Medicaid
TN4071754OtherBCBST
TN4071792OtherBCBST
TN100043255OtherPHP TENNCARE
3886125Medicare PIN
3886127Medicare PIN
TN100043255OtherPHP TENNCARE
TN3886126Medicaid
3886126Medicare PIN
3886129Medicare PIN