Provider Demographics
NPI:1730234139
Name:MCLEMORE, LAURIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANN
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637-3023
Mailing Address - Country:US
Mailing Address - Phone:918-642-3100
Mailing Address - Fax:918-642-5639
Practice Address - Street 1:716 S HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:NEWKIRK
Practice Address - State:OK
Practice Address - Zip Code:74647-7009
Practice Address - Country:US
Practice Address - Phone:580-362-2555
Practice Address - Fax:580-362-2948
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880IMedicaid
OK100768880JMedicaid
OK100192280AMedicaid
OKOK402465OtherMEDICARE PTAN
OKOK402465OtherMEDICARE PTAN
OK100768880JMedicaid
OK100192280AMedicaid
OK371803Medicare Oscar/Certification