Individual
JERRY L LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11705 NW TIMBERVIEW LN, APT 204, PORTLAND, OR 97229-6659
(303) 815-8764
Mailing address
11705 NW TIMBERVIEW LN, APT 204, PORTLAND, OR 97229-6659
(303) 815-8764
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01071935A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201100990
—
IN
Enumeration date
03/30/2011
Last updated
02/02/2015
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