Provider Demographics
NPI:1679877161
Name:LAWRENCE QUAN M.D.P.A
Entity type:Organization
Organization Name:LAWRENCE QUAN M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-594-3639
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-0672
Mailing Address - Country:US
Mailing Address - Phone:936-594-3595
Mailing Address - Fax:936-594-0491
Practice Address - Street 1:315 PROSPECT DR
Practice Address - Street 2:P.O. 672
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-6202
Practice Address - Country:US
Practice Address - Phone:936-594-3595
Practice Address - Fax:936-594-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF4399OtherLICENCE #
TXF4399OtherLICENCE #
TXB2570BMedicare UPIN
TXB115284Medicare PIN