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Individual
DR. LAWRENCE SCOTT MACTAVISH II
Active
Individual
DR. LAWRENCE SCOTT MACTAVISH II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1715
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00448339
RR MEDICARE
TX
05
—
172014602
—
TX
05
—
172014603
—
TX
01
—
80207X
BCBS
TX
01
—
8W6251
BCBS
TX
01
—
P00397523
RR MEDICARE
TX
Enumeration date
07/06/2006
Last updated
02/08/2011
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