Organization
CHAUNCEY B WITCRAFT MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAUNCEY B WITCRAFT III MD (PRESIDENT)
(918) 542-2812
Entity
Organization
Contact information
Practice address
310 2ND AVE SW STE 105, MIAMI, OK 74354-6708
(918) 542-2812
(918) 542-2814
Mailing address
310 2ND AVE SW STE 105, MIAMI, OK 74354-6708
(918) 542-2812
(918) 542-2814
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
13131
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363287549002
BLUE CROSS BLUE SHIELD-OK
OK
Enumeration date
04/20/2007
Last updated
10/04/2007
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