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General NPI Number Information
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NPI Number | 1275512030
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Entity Type | Individual
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Provider Name | LAWRENCE CARROLL AULT III M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 921 NE 13TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5007
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Country | US
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Telephone | 405-456-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 19703 LANSDOWNE ST
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City | ORLANDO
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State | FL
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Zip | 32833-3715
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Country | US
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Telephone | 501-837-3144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | N7862
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | N7862
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License Number State | AR
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