Basic Information
| Provider Information | |||||||||
| NPI: | 1477635662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MASON LAWRENCE MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3650 W ROCK CREEK RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730722202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057013418 | ||||||||
| FaxNumber: | 4057013451 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 W ROCK CREEK RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730722202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057013418 | ||||||||
| FaxNumber: | 4057013451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | LAWRENCE | ||||||||
| AuthorizedOfficialFirstName: | MASON | ||||||||
| AuthorizedOfficialMiddleName: | CLAWDELL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4057013418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 17661 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200276660A | 05 | OK | MEDICAID |