Individual
BLAKE PRUITT CHATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
901 N PORTER AVE, NORMAN, OK 73071-6404
(405) 307-1000
Mailing address
1621 SW 157TH ST, OKLAHOMA CITY, OK 73170-7723
(817) 729-3901
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
8080
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/08/2022
Last updated
10/25/2024
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