Individual
SCOTT LEWIS MICHENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3201 W GORE BLVD, SUITE 201, LAWTON, OK 73505
(580) 357-2261
(580) 357-2263
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
01
—
0915990004
MEDICARE PTAN
OK
05
—
100137220A
—
OK
01
—
P00263322
RAILROAD MEDICARE
OK
Enumeration date
10/12/2005
Last updated
07/10/2010
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