Provider Demographics
NPI:1730164427
Name:LAWSON, GARY ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ANTHONY
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:ANTHONY ORAINE
Other - Last Name:LAWSON-BOUCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:451 BAYFRONT PL
Mailing Address - Street 2:#5209
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6469
Mailing Address - Country:US
Mailing Address - Phone:239-298-9702
Mailing Address - Fax:239-331-4153
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228322-1207L00000X
FLME97767207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93528OtherBCBS
FL277768100Medicaid
FLAB642ZMedicare PIN