Basic Information
| Provider Information | |||||||||
| NPI: | 1467736769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWTON GENERAL SURGERY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 788 | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925460788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519296260 | ||||||||
| FaxNumber: | 9517652855 | ||||||||
| Practice Location | |||||||||
| Address1: | 3805 W GORE BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805811994 | ||||||||
| FaxNumber: | 5805811285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | IGWE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9519296260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25895 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.