Provider Demographics
NPI:1144252800
Name:QUAN, LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:QUAN
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: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:
Practice Address - Street 1:315 PROSPECT DR
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MJ25OtherBLUE CROSS
TX138399404Medicaid
B25708Medicare UPIN
TX00MJ25OtherBLUE CROSS
TXB115285Medicare PIN
TX138399404Medicaid