Individual
JOE M ROUNDTREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 NW 31ST, LAWTON, OK 73505
(580) 536-2121
(580) 536-2150
Mailing address
PO BOX 6130, LAWTON, OK 73506
(580) 536-2121
(580) 536-2150
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12278
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020003594
RAILROAD MEDICARE
OK
05
—
100123090A
—
OK
01
—
37D0686457
CLIA
OK
Enumeration date
10/03/2006
Last updated
01/29/2015
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