MEDICARE: CALEB ALEXANDER

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	208000000X	Pediatrics Physician	41321	OK

General Provider Information

NPI Number	:	1972124204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB ALEXANDER

Provider Business Mailing Address
First Line	:	2617 CHAUCER DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3406
Country	:	US
Telephone Number	:	405-471-9790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2617 CHAUCER DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3406
Country	:	US
Telephone Number	:	405-471-9790
Fax Number	:

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

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	06/30/2023

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Directions to “ CALEB ALEXANDER ” Practice Location

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