Provider Demographics
NPI:1437298965
Name:BURWELL, ROBERT CHAD (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHAD
Last Name:BURWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:BURWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1111 N LEE AVE
Mailing Address - Street 2:STE 236
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2600
Mailing Address - Country:US
Mailing Address - Phone:405-272-9644
Mailing Address - Fax:405-272-0361
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-9644
Practice Address - Fax:405-272-0361
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4283207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200197990AMedicaid
OKOK400729Medicare PIN