Provider Demographics
NPI:1023293933
Name:FITZGERALD, LAUREN L (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:L
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6491
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-6491
Mailing Address - Country:US
Mailing Address - Phone:918-392-2944
Mailing Address - Fax:918-664-2521
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:918-392-2944
Practice Address - Fax:918-664-2521
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29021207L00000X
HI15222207L00000X
CO47956207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200433500AMedicaid
OK318758YP9LMedicare PIN