Healthcare Provider Details

I. General information

NPI: 1003064478
Provider Name (Legal Business Name): LAURA COLEMAN, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5366 NW CACHE RD SUITE 6
LAWTON OK
73505-3335
US

IV. Provider business mailing address

5366 NW CACHE RD SUITE 6
LAWTON OK
73505-3335
US

V. Phone/Fax

Practice location:
  • Phone: 580-536-7546
  • Fax: 580-581-2051
Mailing address:
  • Phone: 580-536-7546
  • Fax: 580-581-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24929
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24929
License Number StateOK

VIII. Authorized Official

Name: LAURA ELIZABETH COLEMAN
Title or Position: OWNER
Credential: M.D.
Phone: 580-536-7546