Provider Demographics
NPI:1467736769
Name:LAWTON GENERAL SURGERY CLINIC
Entity Type:Organization
Organization Name:LAWTON GENERAL SURGERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:951-929-6260
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-0788
Mailing Address - Country:US
Mailing Address - Phone:951-929-6260
Mailing Address - Fax:951-765-2855
Practice Address - Street 1:3805 W GORE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6334
Practice Address - Country:US
Practice Address - Phone:580-581-1994
Practice Address - Fax:580-581-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25895208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty