Healthcare Provider Details

I. General information

NPI: 1376005108
Provider Name (Legal Business Name): AMAR CHANDRA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W. 6TH AVE
STILLWATER OK
74074
US

IV. Provider business mailing address

1323 W. 6TH AVE.
STILLWATER OK
74074
US

V. Phone/Fax

Practice location:
  • Phone: 405-533-8850
  • Fax: 405-533-8853
Mailing address:
  • Phone: 405-533-8850
  • Fax: 405-533-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number404
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: