Provider Demographics
NPI:1326509712
Name:LOTFABADI, ASHLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:LOTFABADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RAMIREZ
Other - Last Name:LOTFABADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1011 HONOR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1318
Mailing Address - Country:US
Mailing Address - Phone:888-397-8387
Mailing Address - Fax:
Practice Address - Street 1:14002 E 21ST ST STE 1130
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-1408
Practice Address - Country:US
Practice Address - Phone:918-439-1500
Practice Address - Fax:918-439-1199
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK7005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program