Provider Demographics
NPI:1740283175
Name:OLLAR-SHOEMAKE, LESLIE JUNE (DO)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JUNE
Last Name:OLLAR-SHOEMAKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 RC LUTTRELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9005
Mailing Address - Country:US
Mailing Address - Phone:405-360-1264
Mailing Address - Fax:405-321-8683
Practice Address - Street 1:3440 RC LUTTRELL DR STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9005
Practice Address - Country:US
Practice Address - Phone:405-360-1264
Practice Address - Fax:405-321-8683
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2024-11-07
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
OK3210207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100132040AMedicaid
OKG70475Medicare UPIN
OK$$$$$$$$$Medicare PIN