Healthcare Provider Details

I. General information

NPI: 1487693743
Provider Name (Legal Business Name): AVIS J LUCAS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N PORTER AVE STE 200
NORMAN OK
73071
US

IV. Provider business mailing address

950 N PORTER AVE STE 200
NORMAN OK
73071-6400
US

V. Phone/Fax

Practice location:
  • Phone: 405-329-0121
  • Fax: 405-292-6099
Mailing address:
  • Phone: 405-329-0121
  • Fax: 405-292-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number618
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: