Organization
COMANCHE COUNTY HEALTHCARE CORPORATION
Active
Other names
MMG Urology
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT SMITH (CFO)
(580) 355-8620
Entity
Organization
Contact information
Practice address
3201 W GORE BLVD, SUITE 201, LAWTON, OK 73505
(580) 357-2261
(580) 354-5990
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
19658
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100810030L
—
OK
Enumeration date
07/27/2006
Last updated
07/16/2024
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