Individual
DR. CHARLES EDWIN LAURENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PO BOX 232, KINGSLAND, TX 78639-0232
(512) 736-1669
Mailing address
PO BOX 232, KINGSLAND, TX 78639-0232
(512) 736-1669
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G1943
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
742237082
TAX ID
TX
Enumeration date
08/02/2006
Last updated
04/15/2026
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