Provider Demographics
NPI:1952561011
Name:ALFRED LAST, M.D.
Entity Type:Organization
Organization Name:ALFRED LAST, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASSY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-5595
Mailing Address - Street 1:3435 NW 56TH ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4448
Mailing Address - Country:US
Mailing Address - Phone:405-947-5535
Mailing Address - Fax:405-947-5417
Practice Address - Street 1:3435 NW 56TH ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4448
Practice Address - Country:US
Practice Address - Phone:405-947-5535
Practice Address - Fax:405-947-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8565207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC95156Medicare UPIN