Individual
CORNELIUS DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2103 NW 50TH ST, LAWTON, OK 73505-3253
(405) 246-5423
Mailing address
2103 NW 50TH ST, LAWTON, OK 73505-3253
(405) 246-5423
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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