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Individual

DR. LAWRENCE SCOTT MACTAVISH II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
17215 RED OAK DR, STE 102, HOUSTON, TX 77090-2611
(281) 444-4114
(281) 453-1269
Mailing address
17215 RED OAK DR, STE 102, HOUSTON, TX 77090-2611
(281) 444-4114
(281) 453-1269

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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