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Individual

DR. LAWRENCE CLAY BROTHERTON III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1725 E 19TH ST, SUITE 800, TULSA, OK 74104-5472
(918) 301-2505
(918) 744-3633
Mailing address
1725 E 19TH ST, SUITE 800, TULSA, OK 74104-5472
(918) 301-2505
(918) 744-3633

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
24398
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200060600A
OK
01
730768966
MEDICARE GROUP PIN
OK
Enumeration date
10/11/2005
Last updated
07/26/2011
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