Provider Demographics
NPI:1962493270
Name:WEBBER, CHADWICK (MD)
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:
Last Name:WEBBER
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:PO BOX 1308
Mailing Address - Street 2:ATTENTION: MANAGED CARE
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1308
Mailing Address - Country:US
Mailing Address - Phone:405-307-1600
Mailing Address - Fax:405-307-1604
Practice Address - Street 1:901 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6404
Practice Address - Country:US
Practice Address - Phone:405-307-1600
Practice Address - Fax:405-307-1604
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK219922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200050770AMedicaid
OK200050770AMedicaid
OK246804205Medicare PIN