1083651699 NPI number — DR. EDWARD CHUA CO M.D.

Table of content: DR. EDWARD CHUA CO M.D. (NPI 1083651699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083651699 NPI number — DR. EDWARD CHUA CO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CO
Provider First Name:
EDWARD
Provider Middle Name:
CHUA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083651699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16804 SHORERUN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73012-8431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-949-6051
Provider Business Mailing Address Fax Number:
405-949-6977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 NW EXPRESSWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-949-6051
Provider Business Practice Location Address Fax Number:
405-949-6977
Provider Enumeration Date:
06/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  17545 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)