Healthcare Provider Details

I. General information

NPI: 1861569063
Provider Name (Legal Business Name): GREGORY LAWTON OJA M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 5TH ST NW
BEMIDJI MN
56601-2915
US

IV. Provider business mailing address

612 5TH ST NW
BEMIDJI MN
56601-2915
US

V. Phone/Fax

Practice location:
  • Phone: 218-444-4444
  • Fax: 218-444-5103
Mailing address:
  • Phone: 218-444-4444
  • Fax: 218-444-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5254
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: