Provider Demographics
NPI:1427240118
Name:CHANDLER CLINIC A DIVISION OF PLAZA MEDICAL GROUP, PC
Entity type:Organization
Organization Name:CHANDLER CLINIC A DIVISION OF PLAZA MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYZMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-948-4040
Mailing Address - Street 1:3433 NW 56TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4430
Mailing Address - Country:US
Mailing Address - Phone:405-948-4040
Mailing Address - Fax:
Practice Address - Street 1:114 N HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-1200
Practice Address - Country:US
Practice Address - Phone:405-258-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAZA MEDICAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty