Provider Demographics
NPI:1144491655
Name:WARDZALA, LAWRENCE JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:WARDZALA
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 1:3562 N TANURI DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1989
Mailing Address - Country:US
Mailing Address - Phone:520-762-5471
Mailing Address - Fax:480-287-9615
Practice Address - Street 1:3562 N TANURI DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1989
Practice Address - Country:US
Practice Address - Phone:520-762-5471
Practice Address - Fax:480-287-9615
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34266207R00000X
FLME55986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine