Healthcare Provider Details

I. General information

NPI: 1588107478
Provider Name (Legal Business Name): MR. LAWRENCE ALLEN BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD
OKLAHOMA CITY OK
73106-6835
US

IV. Provider business mailing address

1330 N CLASSEN BLVD
OKLAHOMA CITY OK
73106-6835
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax: 405-601-6711
Mailing address:
  • Phone: 405-601-6710
  • Fax: 405-601-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: