Provider Demographics
NPI:1144212226
Name:SHANK, LAWRENCE P (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:SHANK
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 1:700 W CENTRAL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-321-8757
Mailing Address - Fax:316-321-8759
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-8757
Practice Address - Fax:316-321-8759
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27463207X00000X
KSKS04-35007207X00000X
OK29078207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100012780HMedicaid
AZ487084.Medicaid
OK200458780AMedicaid
F66005Medicare UPIN
AZ487084.Medicaid
AZZ108696Medicare PIN