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NPI Code Detail

MEDICARE: UNIVERSITY OF OKLAHOMA HEALTH SCIEN CTR SOUTHWEST OK FAMILY PRACTICE

MEDICARE: UNIVERSITY OF OKLAHOMA HEALTH SCIEN CTR SOUTHWEST OK FAMILY PRACTICE
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
1207Q00000XFamily Medicine PhysicianOK

Other Identifiers

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

General Provider Information

NPI Number : 1790893097
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF OKLAHOMA HEALTH SCIEN CTR SOUTHWEST OK FAMILY PRACTICE
Provider Business Mailing Address
First Line : 1202 NW ARLINGTON AVE
Second Line :
City : LAWTON
State : OK
Zip : 73507-6537
Country : US
Telephone Number : 580-248-2288
Fax Number : 580-248-5757
Provider Business Practice Location Address
First Line : 1202 NW ARLINGTON AVE
Second Line :
City : LAWTON
State : OK
Zip : 73507-6537
Country : US
Telephone Number : 580-248-2288
Fax Number : 580-248-5757
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. BRIAN MADDY
Credential :
Telephone Number : 405-271-3932
Provider Enumeration Date : 08/27/2006
Last Update Date : 05/02/2017

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Directions to “UNIVERSITY OF OKLAHOMA HEALTH SCIEN CTR SOUTHWEST OK FAMILY PRACTICE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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