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Individual
DR. LAWRENCE SCOTT MACTAVISH
Active
Individual
DR. LAWRENCE SCOTT MACTAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
506
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J24P
BCBS
TX
05
—
121574101
—
TX
05
—
121574103
—
TX
01
—
480006483
RR MEDICARE
TX
01
—
480029262
RR MEDICARE
TX
01
—
8W6250
BCBS
TX
Enumeration date
06/17/2006
Last updated
02/08/2011
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