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General NPI Number Information
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NPI Number | 1508474792
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Entity Type | Organization
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Legal Business Name | LAWTON GENERAL SURGERY PC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 3414 NW CACHE RD STE F
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City | LAWTON
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State | OK
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Zip | 73505-3878
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Country | US
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Telephone | 580-308-9490
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Fax | 580-308-9491
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Provider Business Mailing Address
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Address Line | PO BOX 7081
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City | LAWTON
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State | OK
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Zip | 73506-1081
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Country | US
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Telephone | 580-308-9490
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Fax | 580-308-9491
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. CHUKWUKADIBIA J ODUNUKWE
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Credential | MD
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Telephone | 580-308-9490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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