Provider Demographics
NPI:1790857019
Name:STILLWATER UROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:STILLWATER UROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAUVETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-377-3858
Mailing Address - Street 1:816 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4349
Mailing Address - Country:US
Mailing Address - Phone:405-377-3858
Mailing Address - Fax:405-624-2771
Practice Address - Street 1:816 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4349
Practice Address - Country:US
Practice Address - Phone:405-377-3858
Practice Address - Fax:405-624-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20088208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBCBS
OK=========001OtherBCBS