Individual
MR. JOHN NELSON LAZENBY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHS, PA-C
Contact information
Practice address
4 E CLARK BASS BLVD STE 302, MCALESTER, OK 74501-4269
(918) 426-4306
Mailing address
6708 TREVI CT, OKLAHOMA CITY, OK 73116-2604
(580) 695-2958
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3133
OK
Other
Enumeration date
01/20/2020
Last updated
01/20/2020
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