Provider Demographics
NPI:1053914036
Name:LACY DAVIS MD PLLC
Entity type:Organization
Organization Name:LACY DAVIS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LACY
Authorized Official - Middle Name:STEPHENS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-513-1870
Mailing Address - Street 1:3418 PERSIMMON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7848
Mailing Address - Country:US
Mailing Address - Phone:405-513-1870
Mailing Address - Fax:
Practice Address - Street 1:195000 E COVELL RD
Practice Address - Street 2:
Practice Address - City:LUTHER
Practice Address - State:OK
Practice Address - Zip Code:73054
Practice Address - Country:US
Practice Address - Phone:405-513-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty