Healthcare Provider Details

I. General information

NPI: 1639248149
Provider Name (Legal Business Name): LANCE E HARDISON DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 S.W. 89
OKLAHOMA CITY OK
73139-9104
US

IV. Provider business mailing address

1126 S.W. 89
OKLAHOMA CITY OK
73139-9104
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-7114
  • Fax: 405-692-2425
Mailing address:
  • Phone: 405-692-7114
  • Fax: 405-692-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number151
License Number StateOK

VIII. Authorized Official

Name: LANCE E HARDISON
Title or Position: OWNER OF CORP
Credential: DPM
Phone: 405-751-6153