Provider Demographics
NPI:1861569063
Name:OJA, GREGORY LAWTON (MS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LAWTON
Last Name:OJA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2915
Mailing Address - Country:US
Mailing Address - Phone:218-444-4444
Mailing Address - Fax:218-444-5103
Practice Address - Street 1:612 5TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2915
Practice Address - Country:US
Practice Address - Phone:218-444-4444
Practice Address - Fax:218-444-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5254237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS21415Medicare UPIN