Organization
ROBERT MILES CHISHOLM III MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT MILES CHISHOLM III MD (PROVIDER)
(580) 353-1616
Entity
Organization
Contact information
Practice address
605 W GORE BLVD, SUITE 6, LAWTON, OK 73501-3727
(580) 353-1616
(580) 353-0052
Mailing address
605 WEST GORE BLVD., SUITE 6, LAWTON, OK 73501-3701
(580) 353-1616
(580) 353-0052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22563
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080185221
RAILROAD MEDICARE
OK
05
—
100108500B
—
OK
01
—
443841662001
BC/ BS
OK
Enumeration date
08/21/2007
Last updated
09/10/2010
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