Provider Demographics
NPI:1720181621
Name:LAWTON FAMILY FOOT CLINIC INC
Entity Type:Organization
Organization Name:LAWTON FAMILY FOOT CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:580-357-8720
Mailing Address - Street 1:5101 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8317
Mailing Address - Country:US
Mailing Address - Phone:580-357-8720
Mailing Address - Fax:580-357-8759
Practice Address - Street 1:5101 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8317
Practice Address - Country:US
Practice Address - Phone:580-357-8720
Practice Address - Fax:580-357-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK153213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========001OtherBCBS
=========001OtherBCBS
0725380001Medicare NSC