Healthcare Provider Details

I. General information

NPI: 1013691542
Provider Name (Legal Business Name): LAUREN OKAMOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR # M349
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR # M349
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 537-882-2276
  • Fax:
Mailing address:
  • Phone: 537-882-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2023022772
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: