Provider Demographics
NPI:1265523476
Name:CAMPION, LAURA C (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:CAMPION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:REGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4400
Mailing Address - Fax:918-619-4322
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:2ND FLOOR, STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4322
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06070018000OtherQUALCHOICE
AR163015001Medicaid
AR163015001Medicaid
AR5N566Medicare PIN