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Individual

LAWRENCE W SMALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
521 INTERSTATE 45 SOUTH, STE 12, HUNTSVILLE, TX 77340
(936) 291-0900
(936) 291-0955
Mailing address
PO BOX 2946, CONROE, TX 77305
(936) 291-0900
(936) 291-0955

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
E8915
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0053JP
BLUE CROSS BLUE SHIELD
TX
01
P00010410
MCR RAILROAD
TX
Enumeration date
07/14/2006
Last updated
07/08/2007
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