Provider Demographics
NPI:1073383840
Name:LOTHRIDGE, JEREMY L
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:L
Last Name:LOTHRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 WESTSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3085
Mailing Address - Country:US
Mailing Address - Phone:580-924-7331
Mailing Address - Fax:580-924-7334
Practice Address - Street 1:698 WESTSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3085
Practice Address - Country:US
Practice Address - Phone:580-924-7331
Practice Address - Fax:580-924-7334
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist