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General NPI Number Information
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NPI Number | 1952582900
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Entity Type | Organization
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Legal Business Name | LAWTON FAMILY PRACTICE & ALLERGY CLINIC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 5604 SW LEE BLVD SUITE 245
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City | LAWTON
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State | OK
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Zip | 73505-9681
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Country | US
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Telephone | 580-536-0071
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Fax | 580-536-9522
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Provider Business Mailing Address
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Address Line | 5604 SW LEE BLVD SUITE 245
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City | LAWTON
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State | OK
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Zip | 73505-9681
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Country | US
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Telephone | 580-536-0071
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Fax | 580-536-9522
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DAVID MAURY
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Credential | MD
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Telephone | 580-536-0071
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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 | 13908
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License Number State | OK
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