Provider Demographics
NPI:1801380159
Name:CRYSTEN CHEATWOOD DO, PC
Entity Type:Organization
Organization Name:CRYSTEN CHEATWOOD DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHEATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-945-4701
Mailing Address - Street 1:3433 NW 56TH STREET
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-945-4701
Mailing Address - Fax:405-945-4728
Practice Address - Street 1:3433 NW 56 STREET
Practice Address - Street 2:SUITE 210B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-945-4701
Practice Address - Fax:405-945-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty