Basic Information
| Provider Information | |||||||||
| NPI: | 1073523791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWYER | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 500 W | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013548225 | ||||||||
| FaxNumber: | 8014298150 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 W 800 N | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840576301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013548205 | ||||||||
| FaxNumber: | 8013548206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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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 | 207R00000X | 036087801 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 036087801 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 2004030793 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 7484405-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 020057300 | 01 | IL | BLACK LUNG | OTHER | 036087801 | 01 | IL | IL STATE LICENSE | OTHER | 077831 | 01 | IL | HEALTH ALLIANCE | OTHER | 08421024 | 01 | IL | BC/BS | OTHER | 290014322 | 01 | IL | RR MEDICARE PIN | OTHER | 371363944 | 01 | IL | IRS TAX ID | OTHER | 036087801 | 05 | IL | MEDICAID | 133586700 | 01 | IL | ACS-OWCP | OTHER | 14D0949277 | 01 | IL | CLIA | OTHER | 468846 | 01 | IL | HEALTHLINK | OTHER | 6394P | 01 | IL | CATERPILLAR | OTHER | CD7143 | 01 | IL | RR MEDICARE GROUP# | OTHER | 170770 | 01 | IL | PERSONAL CARE | OTHER |