Individual
LAURA WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4202 SW LEE BLVD, BUILDING B, SUITE 100, LAWTON, OK 73505-8343
(580) 368-0808
Mailing address
4202 SW LEE BLVD, BUILDING B, SUITE 100, LAWTON, OK 73505-8343
(580) 368-0808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
5101018070
MI
208000000X
Pediatrics Physician
Primary
5855
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101018070
OSTEOPATHIC MEDICAL LICENSE
MI
01
—
5315039961
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
06/22/2009
Last updated
03/11/2020
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