NPIMap

Organization Active NPI

Robert Miles Chisholm III MD PLLC

  • Family Medicine Physician
  • Lawton, OK
National Provider Identifier
1427241728
Registry record updated Sep 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
22563 Issued in OK
Legal business name
ROBERT MILES CHISHOLM III MD PLLC
Practice address
605 W Gore Blvd
Suite 6
Lawton, OK 73501-3727
Phone
(580) 353-1616
Fax
(580) 353-0052
NPI assigned
Aug 21, 2007
Last updated
Sep 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert Miles Chisholm III, MDNPI 1205941762
Title
Provider
Phone
(580) 353-1616

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 22563 OK Primary

Addresses

Primary practice location

605 W Gore Blvd
Suite 6
Lawton, OK 73501-3727

Mailing address

605 West Gore Blvd.
Suite 6
Lawton, OK 73501-3701
Phone (580) 353-1616

Other identifiers 3

IdentifierTypeStateIssuer
443841662001OtherOKBC/ BS
080185221OtherOKRAILROAD MEDICARE
100108500BMedicaidOK

National Provider Directory

National Provider Directory

Locations

605 W Gore Blvd
Ste 6
Lawton, OK 73501
Phone (580) 353-1616

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1427241728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 WEST GORE BLVD.",
            "address_2": "SUITE 6",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735013701",
            "telephone_number": "580-353-1616",
            "fax_number": "580-353-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 W GORE BLVD",
            "address_2": "SUITE 6",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735013727",
            "telephone_number": "580-353-1616",
            "fax_number": "580-353-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT MILES CHISHOLM III MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "CHISHOLM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MILES",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "580-353-1616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "22563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/ BS",
            "identifier": "443841662001",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080185221",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100108500B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.