Provider Demographics
NPI:1205891603
Name:DARDICK, LAWRENCE R (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:DARDICK
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 1:3267 KINGFISHER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3989
Mailing Address - Country:US
Mailing Address - Phone:775-825-0329
Mailing Address - Fax:
Practice Address - Street 1:3267 KINGFISHER DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3989
Practice Address - Country:US
Practice Address - Phone:775-828-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV87352085R0001X
CAA437802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016631Medicaid
E88972Medicare UPIN
NV002016631Medicaid