Basic Information
| Provider Information | |||||||||
| NPI: | 1972532380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWTON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | KEITH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 OMNI DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296729448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648857475 | ||||||||
| FaxNumber: | 8648857476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 06/18/2015 | ||||||||
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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 | 208800000X | 23935 | KS | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 32205 | SC | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 322056 | 05 | SC | MEDICAID |