Provider Demographics
NPI:1750576732
Name:GARBER, LANCE MATTHEWS (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:MATTHEWS
Last Name:GARBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 HILLSDALE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-0467
Mailing Address - Country:US
Mailing Address - Phone:405-312-0663
Mailing Address - Fax:
Practice Address - Street 1:11415 HILLSDALE DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-0467
Practice Address - Country:US
Practice Address - Phone:405-312-0663
Practice Address - Fax:405-631-9315
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK239702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200194730AMedicaid
OKOK401269Medicare PIN