Individual
LAURIE C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
14002 E 21ST ST STE 1130, TULSA, OK 74134-1408
(918) 439-1500
(918) 439-1199
Mailing address
14002 E 21ST ST STE 1130, TULSA, OK 74134-1408
(918) 439-1500
(918) 439-1199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036130673
IL
207Q00000X
Family Medicine Physician
20A10664
CA
207Q00000X
Family Medicine Physician
Primary
2356
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100136290C
—
OK
Enumeration date
03/10/2006
Last updated
02/13/2019
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