Provider Demographics
NPI:1336176973
Name:LAWRENCE, CHARLES ANTHONY II (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:LAWRENCE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1708 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1012
Mailing Address - Country:US
Mailing Address - Phone:913-620-0531
Mailing Address - Fax:
Practice Address - Street 1:940 NE 13TH ST
Practice Address - Street 2:SUITE 4250
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090223842085R0202X
OK301842085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology