Provider Demographics
NPI:1003064478
Name:LAURA COLEMAN, MD PLLC
Entity Type:Organization
Organization Name:LAURA COLEMAN, MD PLLC
Other - Org Name:LAURA COLEMAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-536-7546
Mailing Address - Street 1:5366 NW CACHE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3335
Mailing Address - Country:US
Mailing Address - Phone:580-536-7546
Mailing Address - Fax:580-581-2051
Practice Address - Street 1:5366 NW CACHE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3335
Practice Address - Country:US
Practice Address - Phone:580-536-7546
Practice Address - Fax:580-581-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24929207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty