Individual
DR. GLENN LEE LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 UNIVERSITY DR E, COLLEGE STATION, TX 77840-2661
(409) 691-3300
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J7807
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81X065
BLUE SHIELD
TX
Enumeration date
03/29/2006
Last updated
05/07/2020
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