Provider Demographics
NPI:1912236746
Name:LAWRENCE J. CHASE, M.D., P.C.
Entity type:Organization
Organization Name:LAWRENCE J. CHASE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-634-0358
Mailing Address - Street 1:321 N MALL DR.
Mailing Address - Street 2:BLDG N
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7316
Mailing Address - Country:US
Mailing Address - Phone:435-634-0358
Mailing Address - Fax:435-674-2520
Practice Address - Street 1:321 N MALL DR. BLDG N
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-634-0358
Practice Address - Fax:435-674-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1884801205208200000X
UT208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010695Medicare PIN
UT000010695Medicare PIN
C14394Medicare UPIN
UTC14397Medicare UPIN