Provider Demographics
NPI:1184621054
Name:MODEL, LAWRENCE M (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:MODEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10847 THOMAS LAKE MNR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4937
Mailing Address - Country:US
Mailing Address - Phone:845-598-3334
Mailing Address - Fax:
Practice Address - Street 1:2230 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4637
Practice Address - Country:US
Practice Address - Phone:866-300-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135753207Q00000X
FLME137239207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00916876Medicaid
NYA400134571Medicare PIN
NY32D201Medicare ID - Type Unspecified