Basic Information
| Provider Information | |||||||||
| NPI: | 1174848790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCHENOWER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 NW 31ST ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803573671 | ||||||||
| FaxNumber: | 5803571256 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 NW 31ST ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803573671 | ||||||||
| FaxNumber: | 5803571256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2010 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 299 | OK | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.