Healthcare Provider Details

I. General information

NPI: 1689762858
Provider Name (Legal Business Name): LESLIE J. OLLAR-SHOEMAKE, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 RC LUTTRELL DR STE 200
NORMAN OK
73072-9005
US

IV. Provider business mailing address

3440 RC LUTTRELL DR STE 200
NORMAN OK
73072-9005
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-1264
  • Fax: 405-321-8683
Mailing address:
  • Phone: 405-360-1264
  • Fax: 405-321-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE J OLLAR-SHOEMAKE
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 405-360-1264