Provider Demographics
NPI:1922073055
Name:CHAPMAN, RANDELL B (MD)
Entity Type:Individual
Prefix:
First Name:RANDELL
Middle Name:B
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 NW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1031
Mailing Address - Country:US
Mailing Address - Phone:785-408-2109
Mailing Address - Fax:
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-878-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23723207P00000X
OK14857207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101340AMedicaid
OKOK401975Medicare PIN
KS057428Medicare ID - Type Unspecified
OK100101340AMedicaid