Provider Demographics
NPI:1720078736
Name:LAWRENCE, KEVIN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:LAWRENCE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-3133
Mailing Address - Country:US
Mailing Address - Phone:903-392-8259
Mailing Address - Fax:
Practice Address - Street 1:105 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-3133
Practice Address - Country:US
Practice Address - Phone:903-392-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144952201Medicaid
TX144952205Medicaid
TX0015KAOtherBCBS
H43392Medicare UPIN
TX00837HMedicare PIN
TX8065N1Medicare ID - Type Unspecified
TX0015KAOtherBCBS