Provider Demographics
NPI:1013989912
Name:LOFGREN, KATHRYN J (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:LOFGREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17713 PTARMIGAN LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6544
Mailing Address - Country:US
Mailing Address - Phone:405-285-1599
Mailing Address - Fax:
Practice Address - Street 1:15951 LITTLE AXE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-9088
Practice Address - Country:US
Practice Address - Phone:405-447-0300
Practice Address - Fax:405-701-7631
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32020207Q00000X
OK26003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0187302Medicaid
IA0187302Medicaid
G39635Medicare UPIN