Basic Information
| Provider Information | |||||||||
| NPI: | 1730164427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWSON | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAWSON-BOUCHER | ||||||||
| OtherFirstName: | GARY | ||||||||
| OtherMiddleName: | ANTHONY ORAINE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 451 BAYFRONT PL | ||||||||
| Address2: | #5209 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341026469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392989702 | ||||||||
| FaxNumber: | 2393314153 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TAMPA GENERAL CIR | ||||||||
| Address2: | SUITE A327 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138444396 | ||||||||
| FaxNumber: | 8138444972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 03/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 228322-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | ME97767 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 93528 | 01 | FL | BCBS | OTHER | 277768100 | 05 | FL | MEDICAID |