Provider Demographics
NPI:1598922908
Name:PASCUAL CHAGMAN, VICTOR EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:EDUARDO
Last Name:PASCUAL CHAGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9777 N COUNCIL RD
Mailing Address - Street 2:APT 725
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5500
Mailing Address - Country:US
Mailing Address - Phone:405-527-1075
Mailing Address - Fax:
Practice Address - Street 1:1401 N 4TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1806
Practice Address - Country:US
Practice Address - Phone:405-527-1075
Practice Address - Fax:405-527-1077
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17161207Q00000X
OK27435207Q00000X
VA0101245934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200253300AMedicaid
OKOKA100446Medicare PIN