Basic Information
| Provider Information | |||||||||
| NPI: | 1801420674 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LETSHABO | ||||||||
| FirstName: | THOBO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 N LINCOLN BLVD | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731055108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054247711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 N AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730963351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803236021 | ||||||||
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| ProviderEnumerationDate: | 03/02/2020 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 3166 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.