Provider Demographics
NPI:1891815841
Name:LAWRENCE V DECK, M.D., PC
Entity Type:Organization
Organization Name:LAWRENCE V DECK, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:DECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-607-8945
Mailing Address - Street 1:13321 N MERIDIAN AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8356
Mailing Address - Country:US
Mailing Address - Phone:405-607-8945
Mailing Address - Fax:405-607-8946
Practice Address - Street 1:13321 N MERIDIAN AVE
Practice Address - Street 2:STE 212
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8356
Practice Address - Country:US
Practice Address - Phone:405-607-8945
Practice Address - Fax:405-607-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE27-637Medicare UPIN
OK100522029Medicare ID - Type Unspecified
OKP00039994Medicare ID - Type UnspecifiedRAILROAD