Provider Demographics
NPI:1447240031
Name:LAWRENCE, MICHAEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844737
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4737
Mailing Address - Country:US
Mailing Address - Phone:580-249-3795
Mailing Address - Fax:580-234-3299
Practice Address - Street 1:310 E OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5712
Practice Address - Country:US
Practice Address - Phone:580-249-3795
Practice Address - Fax:580-234-3299
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4206207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200060100AMedicaid
OKI42323Medicare UPIN
OK200060100AMedicaid