Provider Demographics
NPI:1093940462
Name:NETREBA, JAMES LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:NETREBA
Suffix:
Gender:M
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:PO BOX 21157
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1157
Mailing Address - Country:US
Mailing Address - Phone:405-752-3828
Mailing Address - Fax:
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-752-3814
Practice Address - Fax:512-597-2713
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107559207ZC0500X, 207ZP0102X
TXP2744207ZP0102X
OKMD34052207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB154038OtherMEDICARE
TX3004194Medicaid