Provider Demographics
NPI:1104828755
Name:LAMBERT, RAEANNE (DO)
Entity Type:Individual
Prefix:
First Name:RAEANNE
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-3200
Mailing Address - Country:US
Mailing Address - Phone:918-583-7233
Mailing Address - Fax:918-583-7205
Practice Address - Street 1:10711 E 11TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-3200
Practice Address - Country:US
Practice Address - Phone:918-583-7233
Practice Address - Fax:918-583-7205
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880IMedicaid
OK200001830AMedicaid
I21128Medicare UPIN
OK200001830AMedicaid