Organization
COMANCHE COUNTY HEALTHCARE
Active
Other names
MEMORIAL MEDICAL GROUP FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT SMITH (CFO)
(580) 355-8620
Entity
Organization
Contact information
Practice address
3811 W GORE BLVD, SUITE 2, LAWTON, OK 73505-6328
(580) 585-5550
(580) 585-5551
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16850
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100205240A
—
OK
Enumeration date
07/27/2006
Last updated
05/08/2015
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