MEDICARE: LANCE E HARDISON DPM 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	213ES0103X	Foot & Ankle Surgery Podiatrist	151	OK

General Provider Information

NPI Number	:	1639248149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCE E HARDISON DPM PC

Provider Business Mailing Address
First Line	:	1126 S.W. 89
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9104
Country	:	US
Telephone Number	:	405-692-7114
Fax Number	:	405-692-2425

Provider Business Practice Location Address
First Line	:	1126 S.W. 89
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9104
Country	:	US
Telephone Number	:	405-692-7114
Fax Number	:	405-692-2425

Authorized Official
Title or Position	:	OWNER OF CORP
Name	:	LANCE E HARDISON
Credential	:	DPM
Telephone Number	:	405-751-6153

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	11/09/2022

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