Individual
MR. LAWRENCE MONROE GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 CARTER ST, BERRYVILLE, AR 72616-4303
(870) 423-3338
(870) 423-7330
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
E-3465
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126625001
—
AR
05
—
208778200
—
MO
01
—
5M428
AR BLUE SHIELD #
AR
01
—
E-3465
LICENSE
AR
Enumeration date
07/11/2006
Last updated
10/02/2014
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