Individual
MR. CHAUNCEY B WITCRAFT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 2ND AVE SW, STE 105, MIAMI, OK 74354
(918) 542-2812
(918) 542-2814
Mailing address
310 2ND AVE SW, STE 105, MIAMI, OK 74354
(918) 542-2812
(918) 542-2814
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
13131
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363287549002
BLUE CROSS BLUE SHIELD-OK
OK
Enumeration date
06/27/2006
Last updated
10/04/2007
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