Provider Demographics
NPI:1467438788
Name:LASHLEY, FLOYD J JR (MD)
Entity Type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:J
Last Name:LASHLEY
Suffix:JR
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 1:402 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-1230
Mailing Address - Country:US
Mailing Address - Phone:580-875-6212
Mailing Address - Fax:580-875-6221
Practice Address - Street 1:402 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572
Practice Address - Country:US
Practice Address - Phone:580-875-3347
Practice Address - Fax:580-875-2978
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100109350AMedicaid
C95199Medicare UPIN