Individual
DR. ROBERT MILES CHISHOLM III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
605 W GORE BLVD, SUITE 6, LAWTON, OK 73501-3727
(580) 353-1616
(580) 353-0052
Mailing address
605 W GORE BLVD, SUITE 6, LAWTON, OK 73501-3727
(580) 353-1616
(580) 353-0052
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
Primary
22563
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080185221
RAILROAD MEDICARE
—
05
—
100108500B
—
OK
Enumeration date
08/21/2006
Last updated
09/10/2010
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