Provider Demographics
NPI:1417998311
Name:LANTRIP, LINDA G (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:G
Last Name:LANTRIP
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 1:320 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5238
Mailing Address - Country:US
Mailing Address - Phone:405-573-3821
Mailing Address - Fax:405-573-8256
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3821
Practice Address - Fax:405-573-8256
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27932084P0800X
ARE-10922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100076760AMedicaid
OK248534815Medicare ID - Type Unspecified
OKF59196Medicare UPIN