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General NPI Number Information
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NPI Number | 1497915318
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Entity Type | Organization
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Legal Business Name | LAWRENCE M CIBULA MD PC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 300 ROCKEFELLER DR
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City | MUSKOGEE
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State | OK
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Zip | 74401-5075
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Country | US
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Telephone | 918-684-3374
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Fax | 918-684-2196
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Provider Business Mailing Address
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Address Line | PO BOX 2578
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City | MUSKOGEE
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State | OK
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Zip | 74402-2578
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Country | US
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Telephone | 918-684-3374
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Fax | 918-684-2196
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE M CIBULA JR.
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Credential | MD
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Telephone | 918-684-3374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 12161
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License Number State | OK
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