Individual
JEREMY JON LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2808 NW 31ST ST, OKLAHOMA CITY, OK 73112-7407
(405) 848-7555
Mailing address
6306 COX AVE, OKLAHOMA CITY, OK 73149-5118
(405) 226-6784
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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