Provider Demographics
NPI:1043308059
Name:CHACE, JOHN B (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:CHACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:405-701-6170
Practice Address - Street 1:500 E ROBINSON
Practice Address - Street 2:STE 2300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-329-4102
Practice Address - Fax:405-307-5626
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200060960AMedicaid
OKP00397767OtherMEDICARE RAILROAD
OK200060960BMedicaid
OK200060960BMedicaid
800522454Medicare ID - Type Unspecified
OK200060960AMedicaid
OK800522454Medicare PIN
OK249730604Medicare PIN