Provider Demographics
NPI:1023106267
Name:HAKE, LORI LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNN
Last Name:HAKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:JOHNSON HAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4300 BROOKLINE PL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1786
Mailing Address - Country:US
Mailing Address - Phone:405-360-5516
Mailing Address - Fax:
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5305
Practice Address - Country:US
Practice Address - Phone:405-321-4880
Practice Address - Fax:405-573-6684
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1202866Medicaid
F21056Medicare UPIN