Healthcare Provider Details

I. General information

NPI: 1831078609
Provider Name (Legal Business Name): JARDIN ANTHONY LAZARRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 NW 39TH ST APT 205
OKLAHOMA CITY OK
73118-2646
US

IV. Provider business mailing address

915 N ROBINSON AVE
OKLAHOMA CITY OK
73102-5813
US

V. Phone/Fax

Practice location:
  • Phone: 405-977-7097
  • Fax: 405-977-7097
Mailing address:
  • Phone: 405-943-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: