Individual
DR. LAWRENCE SCOTT MACTAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
17215 RED OAK DR, SUITE 102, HOUSTON, TX 77090-2697
(281) 444-4114
(281) 444-7789
Mailing address
17215 RED OAK DR, SUITE 102, HOUSTON, TX 77090-2697
(281) 444-4114
(281) 444-7789
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
506
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J24P
BCBS
TX
05
—
121574101
—
TX
05
—
121574103
—
TX
01
—
480006483
RR MEDICARE
TX
01
—
480029262
RR MEDICARE
TX
01
—
8W6250
BCBS
TX
Enumeration date
06/17/2006
Last updated
02/08/2011
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