MEDICARE: DR. CARY L LACEFIELD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2323	OK

General Provider Information

NPI Number	:	1134101249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARY L LACEFIELD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 405457
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-5457
Country	:	US
Telephone Number	:	405-454-5240
Fax Number	:

Provider Business Practice Location Address
First Line	:	20826 MAIN ST
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9755
Country	:	US
Telephone Number	:	405-454-2404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/14/2012

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