Organization
CHOCTAW MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM THOMAS CHOCTAW M.D. (PRESIDENT)
(626) 938-1165
Entity
Organization
Contact information
Practice address
315 N 3RD AVE STE 200, COVINA, CA 91723-1915
(626) 938-1165
(626) 938-1172
Mailing address
315 N 3RD AVE STE 200, COVINA, CA 91723-1915
(626) 938-1165
(626) 938-1172
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G029056
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G290560
—
CA
Enumeration date
07/25/2006
Last updated
08/22/2020
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