Provider Demographics
NPI:1679533939
Name:LAW, GEORGE S (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:230 N MIDWEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4321
Mailing Address - Country:US
Mailing Address - Phone:405-610-2100
Mailing Address - Fax:405-610-2101
Practice Address - Street 1:230 N MIDWEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4321
Practice Address - Country:US
Practice Address - Phone:405-610-2100
Practice Address - Fax:405-610-2101
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23822208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200028150AMedicaid
OK$$$$$$$$$003OtherBC/BS
OKP00249110Medicare PIN
OK200028150AMedicaid