Basic Information
| Provider Information | |||||||||
| NPI: | 1477609485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHIFF | ||||||||
| FirstName: | LAURENCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 617 | ||||||||
| Address2: | |||||||||
| City: | SOMERTON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853500617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283157910 | ||||||||
| FaxNumber: | 9286271255 | ||||||||
| Practice Location | |||||||||
| Address1: | 3931 STOCKTON HILL RD | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286812121 | ||||||||
| FaxNumber: | 9286812000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 29101 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | AZ0891490 | 01 | AZ | BCBS PROVIDER ID | OTHER | 567612 | 05 | AZ | MEDICAID |