Individual
MARK ALLEN LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
JCT US HWY 160 & NAVAJO ROUTE 35 RED MESA, TEECNOSPOS, AZ 86514
(928) 656-5165
(928) 656-5164
Mailing address
HCR 6100 BOX 30, TEECNOSPOS, AZ 86514
(928) 656-5165
(928) 656-5164
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1845
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06831371
—
NM
05
—
09358251
—
CO
Enumeration date
10/03/2005
Last updated
02/21/2008
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