MEDICARE: AMANDA LAGRECA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	27630	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932381365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LAGRECA MD

Provider Business Mailing Address
First Line	:	PO BOX 269064
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9064
Country	:	US
Telephone Number	:	405-231-3857
Fax Number	:	405-272-7977

Provider Business Practice Location Address
First Line	:	13401 N WESTERN AVE
Second Line	:	SUITE 407
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-1408
Country	:	US
Telephone Number	:	405-252-3494
Fax Number	:	405-252-3498

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

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	03/14/2016

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