Healthcare Provider Details

I. General information

NPI: 1396096632
Provider Name (Legal Business Name): CHANCEN DARWIN HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 S 103RD EAST AVE STE 100
TULSA OK
74146-2445
US

IV. Provider business mailing address

3840 S 103RD EAST AVE STE 100
TULSA OK
74146-2445
US

V. Phone/Fax

Practice location:
  • Phone: 918-921-9700
  • Fax:
Mailing address:
  • Phone: 918-921-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number94-09638
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS022543
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number7971254
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: