Individual
DR. LAURA MARIE BLACK-WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
111 W FORREST AVE STE B, EUFAULA, OK 74432-3205
(918) 490-7011
(918) 490-7015
Mailing address
1515 TOWER DR STE B, MOORE, OK 73160-6181
(405) 307-6668
(405) 758-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4144
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200022700D
—
OK
Enumeration date
11/21/2005
Last updated
02/18/2020
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