Basic Information
| Provider Information | |||||||||
| NPI: | 1467532416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENTZ | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY STE 35 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067610333 | ||||||||
| FaxNumber: | 8067820097 | ||||||||
| Practice Location | |||||||||
| Address1: | 4105 I-27 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067622633 | ||||||||
| FaxNumber: | 8067610431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M4282 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8AK612 | 01 | TX | BCBS CLINIC IND | OTHER | 8BB500 | 01 | TX | BCBS CLINIC B IND | OTHER | 00Y578 | 01 | TX | BCBS CLINIC B GRP | OTHER | 162693901 | 01 | TX | LHC MEDICAID | OTHER | 0095RB | 01 | TX | BCBS CLINIC B GROUP | OTHER | 170791101 | 01 | TX | FIRSTCARE | OTHER | 8F7078 | 01 | TX | BCBS CLINIC B IND | OTHER | 191767601 | 01 | TX | MEDICAID CLINIC B IND | OTHER | 8J9094 | 01 | TX | MEDICARE HOSP | OTHER | 191766801 | 01 | TX | MEDICAID CLINIC B GRP | OTHER | 191767602 | 01 | TX | HOSP MEDICAID TPI | OTHER |