Provider Demographics
NPI:1174550313
Name:LAWRENZI, JAMES DALE (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DALE
Last Name:LAWRENZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 NW 1621ST RD
Mailing Address - Street 2:
Mailing Address - City:BATES CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64011-8395
Mailing Address - Country:US
Mailing Address - Phone:816-226-1182
Mailing Address - Fax:844-384-5035
Practice Address - Street 1:793 NW 1621ST RD
Practice Address - Street 2:
Practice Address - City:BATES CITY
Practice Address - State:MO
Practice Address - Zip Code:64011-8395
Practice Address - Country:US
Practice Address - Phone:816-226-1182
Practice Address - Fax:816-466-8821
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-38315207Q00000X
MO2008021948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209258607Medicaid
42231012OtherBLUE CROSS BLUE SHIELD
MOK44000002Medicare PIN