Individual
MR. CHARLES LEE LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 N PORTER AVE, SUITE 200, NORMAN, OK 73071-6649
(405) 366-8619
Mailing address
1515 N PORTER AVE, SUITE 200, NORMAN, OK 73071-6649
(405) 366-8619
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
12222
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106340A
—
OK
Enumeration date
11/03/2005
Last updated
02/25/2015
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