Provider Demographics
NPI:1033239579
Name:MASHEK, LARA DEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:DEL
Last Name:MASHEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-273-2270
Mailing Address - Fax:405-878-3468
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-273-2270
Practice Address - Fax:405-878-3468
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4184207Q00000X
OK25902208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N103Medicare UPIN