# ABOLGHASEM REZAEI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Medicine & Urgent Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366538183
- **Authorized official:** DR. ABOLGHASEM MARCO REZAEI MD (OWNER)
- **Authorized official phone:** (580) 699-5511

## Contact information

- **Practice address:** 4121 W GORE BLVD, LAWTON, OK 73505-6336
- **Practice address phone:** (580) 699-5511
- **Practice address fax:** (580) 699-5519
- **Mailing address:** 4121 W GORE BLVD, LAWTON, OK 73505-6336
- **Mailing address phone:** (580) 699-5511
- **Mailing address fax:** (580) 995-5196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 23655 | OK | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 03/27/2021