LARA THEOBALD (NPI# 1376690271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376690271 |
| Entity Type | Individual |
| Full Name | LARA THEOBALD |
| Credential | MD |
| Practice Address |
5915 W Memorial Rd Suite 200 Oklahoma City OK 73142-2021 |
| Mailing Address |
5300 N Independence Ave Suite 280 Oklahoma City OK 73112-5556 |
| Practice Telephone | 4057736400 |
| Practice Fax Number | 4056215441 |
| Mailing Telephone | 4057736400 |
| Mailing Fax Number | 4056215441 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2017-06-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
22010 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
5915 W MEMORIAL RD SUITE 200 |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73142-2021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184661977 | Jeffrey B Cruzan | Family Medicine | 5915 W Memorial Rd, Suite 300, Oklahoma City, OK 73142-2021 | 2006-06-01 |
| 1811257983 | Loahn Kelley Gallegos | Family Medicine | 5915 W Memorial Rd, Suite 300, Oklahoma City, OK 73142-2021 | 2012-05-23 |
| 1659683589 | Serena Anderson | Family Medicine | 5915 W Memorial Rd, Suite 300, Oklahoma City, OK 73142-2021 | 2010-07-08 |
| 1760703730 | Allyson Black | Dermatology | 5915 W Memorial Rd, Suite 300, Oklahoma City, OK 73142-2021 | 2010-06-14 |
| 1639499379 | Robert Scott Hooper | Pharmacist | 5915 W Memorial Rd, Suite 110, Oklahoma City, OK 73142-2015 | 2010-06-04 |
| 1205066958 | Charlotte A Coyner-gregory | Family Medicine | 5915 W Memorial Rd, Suite 300, Oklahoma City, OK 73142-2021 | 2009-07-15 |
| 1699921734 | Irim S Yasin | Internal Medicine | 5915 W Memorial Rd, Suite 200, Oklahoma City, OK 73142-2021 | 2008-08-08 |
| 1245404946 | Juli Johnson | Clinical Nurse Specialist | 5915 W Memorial Rd, Suite 200, Oklahoma City, OK 73142-2021 | 2008-04-15 |
| 1780853358 | Thomas Ammen Showalter IIi | Internal Medicine | 5915 W Memorial Rd, Suite 200, Oklahoma City, OK 73142-2021 | 2008-02-27 |
| 1699971911 | Elizabeth Prater | Dermatology | 5915 W Memorial Rd, Suite 300, Oklahoma City, OK 73142-2021 | 2007-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184003790 | Advance Physicians Group LLC | Clinic/Center | 13401 N Macarthur Blvd, Oklahoma City, OK 73142 | 2015-05-28 |
| 1366840084 | Lindsey Jackson | Case Manager/Care Coordinator | 12051 Parkland Pl, Oklahoma City, OK 73142 | 2014-12-11 |
| 1164866737 | Vitality Wellness | Clinic/Center | 5740 Nw 135th St., Oklahoma City, OK 73142 | 2013-04-25 |
| 1356694558 | Joel Mitchell Sprinkle | Community Health Worker | 13100 Brandon Pl, Oklahoma City, OK 73142 | 2012-10-25 |
| 1689923856 | Sampson Mcsidney | Case Management | 14717 Hollyhock Dr, Oklahoma City, OK 73142 | 2012-09-04 |
| 1992087860 | Derek Reed Mccarver | Pharmacist | 1400 E. 2nd St, Edmond, OK 73142 | 2011-09-15 |
| 1326335811 | Laser Spine Surgery Center of Oklahoma, LLC | Clinic/Center | 4727 Gaillardia Parkway, Suite 150, Oklahoma City, OK 73142 | 2011-07-05 |
| 1215220801 | James Kenneth Fisher | Psychologist | 12522 Abbotts Way, Oklahoma City, OK 73142 | 2011-05-16 |
| 1174850408 | Diagnostic Laboratory of Oklahoma, LLC | Clinical Medical Laboratory | 5911 West Memorial Road, Oklahoma City, OK 73142 | 2009-11-06 |
| 1417113275 | Reuben Seth Thomas | Optometrist | 6200 W Memorial Rd Ste A, Oklahoma City, OK 73142 | 2008-07-31 |
| Find all providers in zip 73142 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548725302 | Saint Medical Group, LLC | Internal Medicine | 3525 Nw 56th St Ste 150c, Oklahoma City, OK 73112-4516 | 2019-02-06 |
| 1114430022 | Ssm Health Care of Oklahoma Inc | Internal Medicine | 3525 Nw 56th St Ste 100d, Oklahoma City, OK 73112-4549 | 2017-11-14 |
| 1902137540 | Hassan Hatoum | Internal Medicine | 800 Ne 10th St. Okcc 2001-6, Stephenson Cancer Center//university of Oklahoma Health, Oklahoma City, OK 73104 | 2010-01-21 |
| 1235397654 | Agnel Rajani Raparthi | Internal Medicine | 800 Ne 10th St # 6071, Oklahoma City, OK 73104-5418 | 2008-06-02 |
| 1760534127 | Carla Kurkjian | Internal Medicine | 4401 Mcauley Blvd, Suite 2700, Oklahoma City, OK 73120-8341 | 2007-01-17 |
| 1568400471 | Brian Vincent Geister | Internal Medicine | 5915 W Memorial Road, 200, Oklahoma City, OK 73142 | 2006-06-03 |
| 1306890074 | Saadia Chohan | Internal Medicine | 3525 Nw 56th St, Oklahoma City, OK 73112-4550 | 2006-05-19 |
| 1093767717 | James Wilburn Hampton | Internal Medicine | 11100 Hefner Pointe Dr, Oklahoma City, OK 73120-5049 | 2006-05-17 |
| 1245282888 | Ralph Gershon Ganick | Internal Medicine | 1011 N Dewey Ave, Suite 100, Oklahoma City, OK 73102-1024 | 2006-05-16 |
| 1932151560 | Janae Michelle Clapp | Internal Medicine | 5915 W Memorial Rd Ste 200, Oklahoma City, OK 73142-2022 | 2006-05-16 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73142 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.