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General NPI Number Information
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NPI Number | 1285635409
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Entity Type | Individual
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Provider Name | OSCAR JACK CHASTAIN III MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 701 E MARSHALL AVE SUITE 504
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City | LONGVIEW
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State | TX
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Zip | 75601-5659
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Country | US
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Telephone | 903-315-2777
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Fax | 903-315-2771
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Provider Business Mailing Address
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Address Line | PO BOX 4207
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City | LONGVIEW
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State | TX
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Zip | 75606-4207
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Country | US
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Telephone | 903-315-4119
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Fax | 903-315-4130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | F6524
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License Number State | TX
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