Provider Demographics
NPI:1316637317
Name:MAGRUDER, CHAD BENSON (PRSS)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:BENSON
Last Name:MAGRUDER
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 E 109TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7215
Mailing Address - Country:US
Mailing Address - Phone:918-706-0800
Mailing Address - Fax:
Practice Address - Street 1:8621 E 109TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7215
Practice Address - Country:US
Practice Address - Phone:918-706-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist