Provider Demographics
NPI:1699733899
Name:LENSGRAF, SAMUEL JAY (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAY
Last Name:LENSGRAF
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 1:2816 NW 57TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7042
Mailing Address - Country:US
Mailing Address - Phone:405-848-7882
Mailing Address - Fax:405-848-7818
Practice Address - Street 1:2816 NW 57TH STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7042
Practice Address - Country:US
Practice Address - Phone:405-848-7882
Practice Address - Fax:405-848-7818
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK158762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE29410Medicare UPIN
244528301Medicare ID - Type Unspecified
244528301Medicare PIN