Basic Information
| Provider Information | |||||||||
| NPI: | 1851393813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSNER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 N. CHINA LAKE BLVD SUITE 190 | ||||||||
| Address2: | RIDGECREST RURAL HEALTH CLINIC | ||||||||
| City: | RIDGECREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604993854 | ||||||||
| FaxNumber: | 7604993870 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 N. CHINA LAKE BLVD SUITE 190 | ||||||||
| Address2: | RIDGECREST RURAL HEALTH CLINIC | ||||||||
| City: | RIDGECREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604993855 | ||||||||
| FaxNumber: | 7604993870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2005 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G50371 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G503710 | 01 | BLUE SHIELD | OTHER | 00G503710 | 05 | CA | MEDICAID | AC2320214 | 01 | DEA | OTHER | 00G503710 | 01 | COMMERCIAL INS. | OTHER | 0616650001 | 01 | DME | OTHER | 110039740 | 01 | RAILROAD MEDICARE | OTHER | 182651 | 01 | AHI HEALTHLINK | OTHER | CA0103 | 01 | JOHN DEERE | OTHER | 93555B097 | 01 | TRIWEST/TRICARE | OTHER | 00G503710 | 01 | BLUE CROSS | OTHER |