Individual
LAWRENCE EUGENE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
2401 N.W. 39TH I 44 SERVICE RD, SUITE 103, OKLAHOMA CITY, OK 73112-8739
(405) 557-1655
Mailing address
1308 NE 43RD ST, OKLAHOMA CITY, OK 73111-5853
(405) 824-5066
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
366
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
INSURE OKLAHOMA
OK
01
—
10
INSURE OKLAHOMA
OK
Enumeration date
01/26/2009
Last updated
01/26/2009
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