Provider Demographics
NPI:1316770050
Name:CAMOZZI, CHASEN DOUGLAS
Entity type:Individual
Prefix:
First Name:CHASEN
Middle Name:DOUGLAS
Last Name:CAMOZZI
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 1:3228 CASTLEROCK RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1860
Mailing Address - Country:US
Mailing Address - Phone:405-535-9558
Mailing Address - Fax:
Practice Address - Street 1:2000 N CLASSEN BLVD STE 2600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6027
Practice Address - Country:US
Practice Address - Phone:405-248-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty