Healthcare Provider Details

I. General information

NPI: 1639438237
Provider Name (Legal Business Name): JASON A. LASHLEY, D.P.M.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W. 15TH
EDMOND OK
73013
US

IV. Provider business mailing address

600 W 15TH ST
EDMOND OK
73013-3617
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-9251
  • Fax: 405-340-0686
Mailing address:
  • Phone: 405-340-9251
  • Fax: 405-340-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number294
License Number StateOK

VIII. Authorized Official

Name: JASON A LASHLEY
Title or Position: DPM
Credential: D.P.M.
Phone: 405-733-4441