Lawrence G Wayburn, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD2007-0243 Issued in NM

Practice address

2 Big Bear PL
Santa Fe, NM 87508

Phone

(989) 928-2397

Fax

(505) 471-4388

NPI assigned

Jun 15, 2005

Last updated

Jun 10, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Radiology, PC

  • Diagnostic Radiology Physician
  • Cheboygan, MI
  • NPI 1669487237
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1891790192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 BIG BEAR PL",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87508",
            "telephone_number": "989-928-2397",
            "fax_number": "505-471-4388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BIG BEAR PL",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87508",
            "telephone_number": "989-928-2397",
            "fax_number": "505-471-4388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYBURN",
        "first_name": "LAWRENCE",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NM",
            "license": "MD2007-0243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1891790192",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51282551",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4542150",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marshall Tredway Watson Jr., MD
• Troy Edward Watson, MD
• Valentina Victoria Watson, LPCC
• Kelly Diane Waugaman, AU.D
• Julie Waxenberg, PHARMD
• Victoria Waymire
• Dianne Marie Weaver, D.O.M.
• Julie Weaver
• Suzanne Weaver, LMT
• Carey Ann Webb

• Diagnostic Radiology Physician in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Diagnostic Radiology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.