Provider Demographics
NPI:1295513448
Name:LAPP, GIDEON JOEL (MS)
Entity type:Individual
Prefix:
First Name:GIDEON
Middle Name:JOEL
Last Name:LAPP
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:LAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4034 S 212TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8720
Mailing Address - Country:US
Mailing Address - Phone:717-538-0583
Mailing Address - Fax:
Practice Address - Street 1:1111 W 17TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-1886
Practice Address - Country:US
Practice Address - Phone:918-582-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program