Healthcare Provider Details

I. General information

NPI: 1750576732
Provider Name (Legal Business Name): LANCE MATTHEWS GARBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11415 HILLSDALE DR
EDMOND OK
73013-0467
US

IV. Provider business mailing address

11415 HILLSDALE DR
EDMOND OK
73013-0467
US

V. Phone/Fax

Practice location:
  • Phone: 405-312-0663
  • Fax: 405-631-9315
Mailing address:
  • Phone: 405-312-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23970
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: