Provider Demographics
NPI:1710006093
Name:W J CHOE MD PC
Entity Type:Organization
Organization Name:W J CHOE MD PC
Other - Org Name:CASPER PORTER CHOE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-677-2424
Mailing Address - Street 1:1221 S SUNNYLANE RD
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3018
Mailing Address - Country:US
Mailing Address - Phone:405-677-2424
Mailing Address - Fax:405-677-6740
Practice Address - Street 1:1221 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3018
Practice Address - Country:US
Practice Address - Phone:405-677-2424
Practice Address - Fax:405-677-6740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASPER PORTER CHOE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446648207Medicare PIN
OKD34499Medicare UPIN