Provider Demographics
NPI:1255324109
Name:LAWRENCE, MATTHEW C (MD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:945 GOETHALS DR
Mailing Address - Street 2:STE 300
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-943-3196
Mailing Address - Fax:509-946-0455
Practice Address - Street 1:945 GOETHALS DR
Practice Address - Street 2:STE 300
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-943-3196
Practice Address - Fax:509-946-0455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00037751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8266934Medicaid
WA135957OtherLABOR & INDUSTRY
WA8266934Medicaid
WAAB19265Medicare ID - Type Unspecified