Provider Demographics
NPI:1750421251
Name:DAVAULT, LINDSAY J (MD)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:J
Last Name:DAVAULT
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 1:1400 BRYAN DR STE 307
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2158
Mailing Address - Country:US
Mailing Address - Phone:580-931-3400
Mailing Address - Fax:
Practice Address - Street 1:1400 BRYAN DR STE 307
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2158
Practice Address - Country:US
Practice Address - Phone:580-931-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery