Healthcare Provider Details

I. General information

NPI: 1558623934
Provider Name (Legal Business Name): BRIAN ALAN CHENOWETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST # 1C
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

800 STANTON L YOUNG BLVD # 3400
OKLAHOMA CITY OK
73104-5018
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2663
  • Fax:
Mailing address:
  • Phone: 405-271-4426
  • Fax: 405-271-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29364
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMT212690
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMT212690
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number29364
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: