MEDICARE: DR. DONALD RAY CHADWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	16638	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16638	OTHER	OK	OK MED BOARD

General Provider Information

NPI Number	:	1184741084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD RAY CHADWELL MD

Provider Business Mailing Address
First Line	:	PO BOX 1885
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-1885
Country	:	US
Telephone Number	:	405-650-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 MID AMERICA BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-9998
Country	:	US
Telephone Number	:	405-650-0306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	12/31/2020

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