Individual
PHILLIP CHASTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Mailing address
6707 S RICHMOND AVE UNIT 649, TULSA, OK 74136-4634
(191) 863-8608
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100737580A
—
OK
Enumeration date
04/20/2021
Last updated
04/20/2021
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