Basic Information
| Provider Information | |||||||||
| NPI: | 1558369090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWSON | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH, FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4815 ALAMEDA AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155441200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 POTASIO DR | ||||||||
| Address2: | |||||||||
| City: | FABENS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157645000 | ||||||||
| FaxNumber: | 9157645050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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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 | 208000000X | H9535 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | H9535 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 124896501 | 05 | TX | MEDICAID |