Healthcare Provider Details

I. General information

NPI: 1225095938
Provider Name (Legal Business Name): JAMES E. CHEATHAM JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES CHEATHAM JR. M.D.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MEMORIAL RD FL 3
OKLAHOMA CITY OK
73120-8382
US

IV. Provider business mailing address

7800 NW 85TH TER
OKLAHOMA CITY OK
73132-3385
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-3800
  • Fax: 405-608-4739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number11182
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: