Healthcare Provider Details

I. General information

NPI: 1528097904
Provider Name (Legal Business Name): HILLARY SETH LAWRENCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 E 15TH ST
EDMOND OK
73013-5029
US

IV. Provider business mailing address

1354 E 15TH ST
EDMOND OK
73013-5029
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-8823
  • Fax: 405-285-8824
Mailing address:
  • Phone: 405-285-8823
  • Fax: 405-285-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2008029017
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008029017
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008029017
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number2008029017
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: