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NPI Code Detail

MEDICARE: LAURIE C CLARK DO

MEDICARE: LAURIE C CLARK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician20A10664CA
2207Q00000XFamily Medicine Physician036130673IL
3207Q00000XFamily Medicine Physician2356OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801864178
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE C CLARK DO
Provider Business Mailing Address
First Line : 14002 E 21ST ST STE 1130
Second Line :
City : TULSA
State : OK
Zip : 74134-1408
Country : US
Telephone Number : 918-439-1500
Fax Number : 918-439-1199
Provider Business Practice Location Address
First Line : 14002 E 21ST ST STE 1130
Second Line :
City : TULSA
State : OK
Zip : 74134-1408
Country : US
Telephone Number : 918-439-1500
Fax Number : 918-439-1199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 02/13/2019

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Directions to “ LAURIE C CLARK DO” Practice Location

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