Individual
DR. LAWRENCE WAYNE SHIVERTAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2486 SHALIMAR LN, ORANGE PARK, FL 32073-6123
(904) 269-5274
Mailing address
2486 SHALIMAR LN, ORANGE PARK, FL 32073-6123
(904) 269-5274
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
ME60157
FL
Other
Enumeration date
01/25/2009
Last updated
01/25/2009
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