Individual
DR. LISHA SUSAN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
900 NE 10TH ST, OKLAHOMA CITY, OK 73104-5420
(405) 271-9995
(405) 271-3621
Mailing address
6745 NW 125TH CT, OKLAHOMA CITY, OK 73142-5193
(214) 714-4813
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0734R
OK
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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