Healthcare Provider Details

I. General information

NPI: 1639249139
Provider Name (Legal Business Name): PADMASHREE VELURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 W GORE BLVD SUITE B-3
LAWTON OK
73505-5977
US

IV. Provider business mailing address

5602 SW LEE BLVD
LAWTON OK
73505-9635
US

V. Phone/Fax

Practice location:
  • Phone: 580-536-5300
  • Fax: 580-536-5304
Mailing address:
  • Phone: 580-531-6408
  • Fax: 580-531-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number24968
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: