MEDICARE: ALAN E AYCOCK M.D.

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	207Y00000X	Otolaryngology Physician	9481	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568464725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN E AYCOCK M.D.

Provider Business Mailing Address
First Line	:	5402 SW LEE BLVD.
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-1256
Country	:	US
Telephone Number	:	580-531-0022
Fax Number	:	580-531-0026

Provider Business Practice Location Address
First Line	:	5402 SW LEE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-9521
Country	:	US
Telephone Number	:	580-531-0022
Fax Number	:	580-531-0026

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/04/2011

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