Individual
LAWRENCE G WAYBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 BIG BEAR PL, SANTA FE, NM 87508
(989) 928-2397
(505) 471-4388
Mailing address
2 BIG BEAR PL, SANTA FE, NM 87508
(989) 928-2397
(505) 471-4388
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD2007-0243
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891790192
NPI
—
05
—
4542150
—
MI
05
—
51282551
—
NM
Enumeration date
06/15/2005
Last updated
06/10/2016
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