Provider Demographics
NPI:1477635662
Name:MASON LAWRENCE MD PC
Entity Type:Organization
Organization Name:MASON LAWRENCE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:CLAWDELL
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-701-3418
Mailing Address - Street 1:3650 W ROCK CREEK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2202
Mailing Address - Country:US
Mailing Address - Phone:405-701-3418
Mailing Address - Fax:405-701-3451
Practice Address - Street 1:3650 W ROCK CREEK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-701-3418
Practice Address - Fax:405-701-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17661207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200276660AMedicaid
OK200276660AMedicaid