Provider Demographics
NPI:1831078609
Name:LAZARRE, JARDIN ANTHONY
Entity type:Individual
Prefix:
First Name:JARDIN
Middle Name:ANTHONY
Last Name:LAZARRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-5813
Mailing Address - Country:US
Mailing Address - Phone:405-943-3700
Mailing Address - Fax:
Practice Address - Street 1:1812 NW 39TH ST APT 205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2646
Practice Address - Country:US
Practice Address - Phone:405-977-7097
Practice Address - Fax:405-977-7097
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist