Provider Demographics
NPI:1467532416
Name:LENTZ, JASON BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRADLEY
Last Name:LENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:4105 I-27
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404
Practice Address - Country:US
Practice Address - Phone:806-762-2633
Practice Address - Fax:806-761-0431
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AK612OtherBCBS CLINIC IND
TX8BB500OtherBCBS CLINIC B IND
TX00Y578OtherBCBS CLINIC B GRP
TX162693901OtherLHC MEDICAID
TX0095RBOtherBCBS CLINIC B GROUP
TX170791101OtherFIRSTCARE
TX8F7078OtherBCBS CLINIC B IND
TX191767601OtherMEDICAID CLINIC B IND
TX8J9094OtherMEDICARE HOSP
TX191766801OtherMEDICAID CLINIC B GRP
TX191767602OtherHOSP MEDICAID TPI
TX8AK612OtherBCBS CLINIC IND