Provider Demographics
NPI:1104034958
Name:ROSSON, LANCE ELLIOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ELLIOTT
Last Name:ROSSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N SHARTEL AVE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2400
Mailing Address - Country:US
Mailing Address - Phone:405-236-1900
Mailing Address - Fax:405-236-0362
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 1104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-236-1900
Practice Address - Fax:405-236-0362
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine