Healthcare Provider Details

I. General information

NPI: 1245440056
Provider Name (Legal Business Name): DAVID H CHANSOLME MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 S WESTERN AVE SUITE 4010
OKLAHOMA CITY OK
73109-3447
US

IV. Provider business mailing address

PO BOX 720486
NORMAN OK
73070-4357
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-6464
  • Fax: 405-644-6465
Mailing address:
  • Phone: 405-644-6464
  • Fax: 405-644-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number23723
License Number StateOK

VIII. Authorized Official

Name: DAVID H CHANSOLME
Title or Position: PRESIDENT
Credential: MD
Phone: 405-644-6464