Provider Demographics
NPI:1801277330
Name:CHAPMAN, GARRY
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 S 94TH ST W
Mailing Address - Street 2:
Mailing Address - City:OKTAHA
Mailing Address - State:OK
Mailing Address - Zip Code:74450-4735
Mailing Address - Country:US
Mailing Address - Phone:918-869-7700
Mailing Address - Fax:
Practice Address - Street 1:10101 S 94TH ST W
Practice Address - Street 2:
Practice Address - City:OKTAHA
Practice Address - State:OK
Practice Address - Zip Code:74450-4735
Practice Address - Country:US
Practice Address - Phone:918-869-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91338367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered