Provider Demographics
NPI:1730116633
Name:WITCRAFT, CHAUNCEY B III (MD)
Entity Type:Individual
Prefix:MR
First Name:CHAUNCEY
Middle Name:B
Last Name:WITCRAFT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:310 2ND AVE SW, STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354
Mailing Address - Country:US
Mailing Address - Phone:918-542-2812
Mailing Address - Fax:918-542-2814
Practice Address - Street 1:310 2ND AVE SW, STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-542-2812
Practice Address - Fax:918-542-2814
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK363287549002OtherBLUE CROSS BLUE SHIELD-OK
OK363287549002OtherBLUE CROSS BLUE SHIELD-OK