# CHAUNCEY B WITCRAFT MD PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285852947
- **Authorized official:** MR. CHAUNCEY B WITCRAFT III MD (PRESIDENT)
- **Authorized official phone:** (918) 542-2812

## Contact information

- **Practice address:** 310 2ND AVE SW STE 105, MIAMI, OK 74354-6708
- **Practice address phone:** (918) 542-2812
- **Practice address fax:** (918) 542-2814
- **Mailing address:** 310 2ND AVE SW STE 105, MIAMI, OK 74354-6708
- **Mailing address phone:** (918) 542-2812
- **Mailing address fax:** (918) 542-2814

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 13131 | OK | Yes |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 10/04/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 363287549002 | BLUE CROSS BLUE SHIELD-OK | OK |