Provider Demographics
NPI:1285635409
Name:CHASTAIN, OSCAR JACK III (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:JACK
Last Name:CHASTAIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:O.
Other - Middle Name:J
Other - Last Name:CHASTAIN
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-315-4119
Mailing Address - Fax:903-315-4130
Practice Address - Street 1:701 E MARSHALL AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5659
Practice Address - Country:US
Practice Address - Phone:903-315-2777
Practice Address - Fax:903-315-2771
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6524208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043391401Medicaid
TX043391401Medicaid