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General NPI Number Information
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NPI Number | 1730765298
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Entity Type | Individual
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Provider Name | LANCE MWANGI MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 20 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-5722
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Country | US
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Telephone | 580-223-3411
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Fax | 580-226-2284
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Provider Business Mailing Address
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Address Line | 1104 WALNUT DR
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City | ARDMORE
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State | OK
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Zip | 73401-2353
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Country | US
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Telephone | 580-226-0543
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Fax | 580-226-2284
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 44293
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License Number State | OK
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