Provider Demographics
NPI:1942280425
Name:LAWSON, BRADLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4265
Mailing Address - Country:US
Mailing Address - Phone:918-494-9341
Mailing Address - Fax:918-494-9355
Practice Address - Street 1:13616 E 103RD ST N STE B
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4592
Practice Address - Country:US
Practice Address - Phone:918-272-4488
Practice Address - Fax:918-481-7611
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK28744207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200397520AMedicaid