Provider Demographics
NPI:1538511936
Name:LAWTON, GLEN
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:LAWTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 W LOUISVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8420
Mailing Address - Country:US
Mailing Address - Phone:918-258-6604
Mailing Address - Fax:
Practice Address - Street 1:1213 W LOUISVILLE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8420
Practice Address - Country:US
Practice Address - Phone:918-258-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator