Healthcare Provider Details

I. General information

NPI: 1952144032
Provider Name (Legal Business Name): JOSHUA LAMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

IV. Provider business mailing address

5411 MAPLEWOOD LN
SAPULPA OK
74066-9123
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-8620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1186R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: