Healthcare Provider Details

I. General information

NPI: 1124011150
Provider Name (Legal Business Name): EDNA C SOLITARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD SUITE 100
LAWTON OK
73505-6378
US

IV. Provider business mailing address

3201 W GORE BLVD SUITE 100
LAWTON OK
73505-6378
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-8942
  • Fax: 580-353-5008
Mailing address:
  • Phone: 580-353-8942
  • Fax: 580-353-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19988
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number19988
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: