Healthcare Provider Details

I. General information

NPI: 1336148667
Provider Name (Legal Business Name): MICHAEL AJ SAWYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 31ST ST 3RD FLOOR
LAWTON OK
73505-6100
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-510-7042
  • Fax: 580-510-7044
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number24092
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: