Provider Demographics
NPI:1770590382
Name:LAUVETZ, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:LAUVETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4349
Mailing Address - Country:US
Mailing Address - Phone:405-377-3858
Mailing Address - Fax:405-624-2771
Practice Address - Street 1:816 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4349
Practice Address - Country:US
Practice Address - Phone:405-377-3858
Practice Address - Fax:405-624-2771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37D0473506OtherCLIA
OK37D0473506OtherCLIA
OKC95158Medicare UPIN