MEDICARE: DR. SAMUEL JAY LENSGRAF MD

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	2084P0800X	Psychiatry Physician	15876	OK

General Provider Information

NPI Number	:	1699733899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL JAY LENSGRAF MD

Provider Business Mailing Address
First Line	:	2816 NW 57TH ST
Second Line	:	SUITE 104
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7042
Country	:	US
Telephone Number	:	405-848-7882
Fax Number	:	405-848-7818

Provider Business Practice Location Address
First Line	:	2816 NW 57TH STREET
Second Line	:	SUITE 104
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7042
Country	:	US
Telephone Number	:	405-848-7882
Fax Number	:	405-848-7818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/18/2014

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