Provider Demographics
NPI:1932785730
Name:DAUTEL, LAWRENCE HARVEY IV (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:HARVEY
Last Name:DAUTEL
Suffix:IV
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 1:11570 MILL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTER
Mailing Address - State:LA
Mailing Address - Zip Code:70777-4505
Mailing Address - Country:US
Mailing Address - Phone:225-301-1994
Mailing Address - Fax:
Practice Address - Street 1:700 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5004
Practice Address - Country:US
Practice Address - Phone:405-271-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program