Healthcare Provider Details

I. General information

NPI: 1386765337
Provider Name (Legal Business Name): BEBECITOS CHILDRENS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 NW CACHE RD
LAWTON OK
73505-3634
US

IV. Provider business mailing address

PO BOX 6521
LAWTON OK
73506-0521
US

V. Phone/Fax

Practice location:
  • Phone: 580-351-9949
  • Fax: 580-351-9989
Mailing address:
  • Phone: 580-351-9949
  • Fax: 580-351-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUG MORROW
Title or Position: CREDENTIALING SPEC
Credential:
Phone: 580-475-0175