1003911900 NPI number — DR. ROBERT GUSTAVE LAWSON D.P.M.

Table of content: DR. ROBERT GUSTAVE LAWSON D.P.M. (NPI 1003911900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003911900 NPI number — DR. ROBERT GUSTAVE LAWSON D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWSON
Provider First Name:
ROBERT
Provider Middle Name:
GUSTAVE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003911900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 S ESCONDIDO BLVD
Provider Second Line Business Mailing Address:
PMB #144
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92025-4116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-715-3656
Provider Business Mailing Address Fax Number:
760-233-1265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15644 POMERADO RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-1494
Provider Business Practice Location Address Fax Number:
858-485-1515
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  E3710 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ER0200X , with the licence number: RHD 134777 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X , with the licence number: E3710 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: E3710 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: E3710 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000E37100 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480018837 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com