Active NPI
Lisha Susan Jacob, DO
- Family Medicine Physician
- Oklahoma City, OK
National Provider Identifier
1992549232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0734R
- Practice address
- 900 NE 10TH St
Oklahoma City, OK 73104-5420 - Phone
- (405) 271-9995
- Fax
- (405) 271-3621
- NPI assigned
- Jun 21, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0734R | OK | Primary |
Addresses
Primary practice location
900 NE 10TH St
Oklahoma City, OK 73104-5420
Mailing address
6745 NW 125TH CT
Oklahoma City, OK 73142-5193
Phone (214) 714-4813
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0734R | OK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718928000000",
"number": "1992549232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6745 NW 125TH CT",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731425193",
"telephone_number": "214-714-4813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 NE 10TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731045420",
"telephone_number": "405-271-9995",
"fax_number": "405-271-3621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "LISHA",
"middle_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-21",
"last_updated": "2024-06-21",
"certification_date": "2024-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "0734R",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.