Healthcare Provider Details

I. General information

NPI: 1760566293
Provider Name (Legal Business Name): LEWIS J LITWACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7936 US HWY 277
ELGIN OK
73538
US

IV. Provider business mailing address

PO BOX 2309
LAWTON OK
73502-2309
US

V. Phone/Fax

Practice location:
  • Phone: 580-492-6900
  • Fax: 580-492-6902
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24725
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: