Individual
DR. LAWRENCE LARAY GIPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 MCKEAN AVE, CHARLEROI, PA 15022-1416
(724) 483-8065
(724) 565-5110
Mailing address
PO BOX 212, CHARLEROI, PA 15022-0212
(724) 483-8065
(724) 565-5110
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD020526E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009070000001
—
PA
01
—
1011634
GATEWAY
PA
01
—
1478243
UMWA
PA
01
—
180012945
RAILROAD MEDICARE
PA
01
—
60198
UNISON
PA
01
—
77999
AETNA US HEALTH CARE
PA
01
—
P019692
CHAMPUS
PA
Enumeration date
06/21/2005
Last updated
09/07/2011
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