Provider Demographics
NPI:1548247554
Name:LAWSON, ROBERT B (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S UTICA AVE
Mailing Address - Street 2:SUITE 2123
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4012
Mailing Address - Country:US
Mailing Address - Phone:918-579-5402
Mailing Address - Fax:918-579-5404
Practice Address - Street 1:1120 S UTICA AVE
Practice Address - Street 2:SUITE 2123
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4012
Practice Address - Country:US
Practice Address - Phone:918-579-5402
Practice Address - Fax:918-579-5404
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23792080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160477901Medicaid
MO209899905Medicaid
AR133958003Medicaid
OK100096210AMedicaid
KS100363140AMedicaid
MO209899905Medicaid
TX160477901Medicaid