Provider Demographics
NPI:1447443478
Name:LAMPRICH, BRADLEY KEITH (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KEITH
Last Name:LAMPRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7422
Mailing Address - Country:US
Mailing Address - Phone:405-775-4241
Mailing Address - Fax:405-841-9385
Practice Address - Street 1:236 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7422
Practice Address - Country:US
Practice Address - Phone:405-775-4241
Practice Address - Fax:405-841-9385
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK258402085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology