Provider Demographics
NPI:1780667378
Name:SOUTHWARD, LAUREN BROOKS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BROOKS
Last Name:SOUTHWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1111 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2354
Mailing Address - Country:US
Mailing Address - Phone:580-223-9008
Mailing Address - Fax:580-223-5051
Practice Address - Street 1:1111 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2354
Practice Address - Country:US
Practice Address - Phone:580-223-9008
Practice Address - Fax:580-223-9114
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100850310BMedicaid
OKH70376Medicare UPIN
OK100850310BMedicaid