1063477743 NPI number — DR. CHRISTOPHER MARK LAWLER M.D.

Table of content: DR. CHRISTOPHER MARK LAWLER M.D. (NPI 1063477743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063477743 NPI number — DR. CHRISTOPHER MARK LAWLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWLER
Provider First Name:
CHRISTOPHER
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1063477743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33422 GALLEON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-770-2794
Provider Business Mailing Address Fax Number:
949-305-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32840 PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
E
Provider Business Practice Location Address City Name:
DANA POINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92629-3468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-770-2794
Provider Business Practice Location Address Fax Number:
949-305-3380
Provider Enumeration Date:
04/18/2006

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: 208100000X , with the licence number:  G55969 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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