Healthcare Provider Details

I. General information

NPI: 1023293933
Provider Name (Legal Business Name): LAUREN L. FITZGERALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

PO BOX 6491
NORMAN OK
73070-6491
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-2944
  • Fax: 918-664-2521
Mailing address:
  • Phone: 918-392-2944
  • Fax: 918-664-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29021
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15222
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number47956
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: