MEDICARE: MR. JOHN C VALLANDIGHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	24142	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265438501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN C VALLANDIGHAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 929
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73023-0929
Country	:	US
Telephone Number	:	405-896-8058
Fax Number	:	855-223-1999

Provider Business Practice Location Address
First Line	:	304 S 29TH ST
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-2501
Country	:	US
Telephone Number	:	405-896-8058
Fax Number	:	855-223-1999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/21/2022

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