Provider Demographics
NPI:1578532107
Name:LACKEY, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:LACKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-949-6945
Mailing Address - Fax:405-949-6948
Practice Address - Street 1:3330 NW EXPRESSWAY STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-945-5275
Practice Address - Fax:405-945-5232
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK10434207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100111670BMedicaid
OK310500YKW9Medicare PIN
OKE-15991Medicare UPIN
OK100111670BMedicaid
OK731080651OtherTAX ID NUMBER
OK100111670AMedicaid
OK249731402Medicare PIN