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Individual

TODD K LAWRENCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1825 LOGAN AVE, WATERLOO, IA 50703
Mailing address
1825 LOGAN AVE, WATERLOO, IA 50703-1916
(319) 235-3697

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34751
IA
207Q00000X
Family Medicine Physician
34751
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1790772614
BLUE SHIELD
IA
05
1790772614
IA
Enumeration date
10/05/2005
Last updated
03/07/2023
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