1225095938 NPI number — JAMES E. CHEATHAM JR. M.D.

Table of content: JAMES E. CHEATHAM JR. M.D. (NPI 1225095938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225095938 NPI number — JAMES E. CHEATHAM JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEATHAM
Provider First Name:
JAMES
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
CHEATHAM
Provider Other First Name:
JAMES
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225095938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7800 NW 85TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73132-3385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4050 W MEMORIAL RD FL 3
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:
73120-8382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-608-3800
Provider Business Practice Location Address Fax Number:
405-608-4739
Provider Enumeration Date:
04/27/2006

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: 208G00000X , with the licence number:  11182 , 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)

  • Identifier: 100105960A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: C7119 . This is a "BLUELINCS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".