Healthcare Provider Details

I. General information

NPI: 1275512030
Provider Name (Legal Business Name): LAWRENCE CARROLL AULT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

19703 LANSDOWNE ST
ORLANDO FL
32833-3715
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-4575
  • Fax:
Mailing address:
  • Phone: 501-837-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN7862
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberN7862
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: