MEDICARE: CHANCEN DARWIN HALL

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	207L00000X	Anesthesiology Physician	94-09638	KS
2	207L00000X	Anesthesiology Physician	OS022543	PA
3	247200000X	Other Technician
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	7971254	ID

General Provider Information

NPI Number	:	1396096632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANCEN DARWIN HALL

Provider Business Mailing Address
First Line	:	3840 S 103RD EAST AVE STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-2445
Country	:	US
Telephone Number	:	918-921-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 S 103RD EAST AVE STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-2445
Country	:	US
Telephone Number	:	918-921-9700
Fax Number	:

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

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	08/06/2025

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Directions to “ CHANCEN DARWIN HALL ” Practice Location

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