Provider Demographics
NPI:1467495911
Name:DECK, LAWRENCE VIVIAN III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:VIVIAN
Last Name:DECK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13321 N MERIDIAN AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8356
Mailing Address - Country:US
Mailing Address - Phone:405-607-8945
Mailing Address - Fax:405-607-8946
Practice Address - Street 1:13321 N MERIDIAN AVE
Practice Address - Street 2:STE 400A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8356
Practice Address - Country:US
Practice Address - Phone:405-607-8945
Practice Address - Fax:405-607-8946
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE27637Medicare UPIN
OK100522029Medicare ID - Type UnspecifiedMEDICARE