Provider Demographics
NPI:1851131908
Name:LAWRENCE, ERIC
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DALEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2209
Mailing Address - Country:US
Mailing Address - Phone:251-423-1934
Mailing Address - Fax:
Practice Address - Street 1:815 DALEWOOD PL
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2209
Practice Address - Country:US
Practice Address - Phone:251-423-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver