MEDICARE: CHARLES L. LACKEY MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	12222	OK

General Provider Information

NPI Number	:	1144235995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES L. LACKEY MD, PC

Provider Business Mailing Address
First Line	:	1515 N PORTER AVE STE 200
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-6654
Country	:	US
Telephone Number	:	405-366-8619
Fax Number	:	405-366-1839

Provider Business Practice Location Address
First Line	:	1515 NORTH PORTER AVE
Second Line	:	SUITE 200
City	:	NORMAN
State	:	OK
Zip	:	73071-6446
Country	:	US
Telephone Number	:	405-366-8619
Fax Number	:	405-366-1839

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT M HOLBROOK
Credential	:	MD
Telephone Number	:	405-366-8619

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	10/22/2025

Similar Medicare Providers

1497738629 — KATHY L WYANT M.D.
Practice Location Address:

1125 N PORTER , SUITE 100
NORMAN, OK
73071-6446

Practice Phone: 405-364-1071
Practice Fax:

1801824503 — ROBERT M. HOLBROOK MD, PLLC
Practice Location Address:

1125 N PORTER AVE , SUITE 206
NORMAN, OK
73071-6446

Practice Phone: 405-366-8619
Practice Fax: 405-366-1839

1851321525 — CHARLOTTE KELLY ROSKO PHD
Practice Location Address:

1125 N PORTER AVE , STE 303
NORMAN, OK
73071-6446

Practice Phone: 405-364-3804
Practice Fax: 405-292-3640

1831129501 — CHARLOTTE KELLY ROSKO PHD INC
Practice Location Address:

1125 N PORTER AVE , STE 303
NORMAN, OK
73071-6446

Practice Phone: 405-364-3804
Practice Fax: 405-292-3640

1356372437 — ASSOCIATES IN CLINICAL & COUNSELING PSYCHOLOGY INC
Practice Location Address:

1125 N PORTER AVE , SUITE 303
NORMAN, OK
73071-6446

Practice Phone: 405-364-3804
Practice Fax: 405-292-3640

1013937291 — DR. AUBREY O. WASHINGTON PH.D.
Practice Location Address:

1125 N PORTER AVE , SUITE 303
NORMAN, OK
73071-6446

Practice Phone: 405-364-3804
Practice Fax: 405-292-3640

Directions to “CHARLES L. LACKEY MD, PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.