Healthcare Provider Details

I. General information

NPI: 1063445930
Provider Name (Legal Business Name): LAWRENCE E VARK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31870 E. HWY 51
COWETA OK
74429
US

IV. Provider business mailing address

PO BOX 400
OKMULGEE OK
74447-0400
US

V. Phone/Fax

Practice location:
  • Phone: 918-279-3200
  • Fax:
Mailing address:
  • Phone: 918-756-3334
  • Fax: 918-752-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2932
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: