| Robert Miles Chisholm Iii Md Pllc | |
|
605 W Gore Blvd Suite 6 Lawton OK 73501-3727 | |
| (580) 353-1616 | |
| (580) 353-0052 |
| Full Name | Robert Miles Chisholm Iii Md Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 605 W Gore Blvd, Lawton, Oklahoma |
| Authorized Official Name and Position | Robert Miles Chisholm (PROVIDER) |
| Authorized Official Contact | 5803531616 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Miles Chisholm Iii Md Pllc 605 West Gore Blvd. Suite 6 Lawton OK 73501-3701 Ph: (580) 353-1616 | Robert Miles Chisholm Iii Md Pllc 605 W Gore Blvd Suite 6 Lawton OK 73501-3727 Ph: (580) 353-1616 |
| NPI Number | 1427241728 |
|---|---|
| Provider Enumeration Date | 08/21/2007 |
| Last Update Date | 09/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427241728 | NPI | - | NPPES |
| 443841662001 | Other | OK | BC/ BS |
| 080185221 | Other | OK | RAILROAD MEDICARE |
| 100108500B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 22563 (Oklahoma) | Primary |
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Memorial Medical Group Minor Emergency Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4411 W Gore Blvd, Suite A2, Lawton, OK 73505 Phone: 580-355-0575 Fax: 580-248-1725 | |
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