Healthcare Provider Details

I. General information

NPI: 1376538280
Provider Name (Legal Business Name): CLAUDIA J TYBURSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NW 31ST
LAWTON OK
73505
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-6790
  • Fax: 580-510-7019
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5692302
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18276
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: