Basic Information
| Provider Information | |||||||||
| NPI: | 1437131208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHISUM | ||||||||
| FirstName: | AULTON | ||||||||
| MiddleName: | DALE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15954 S BROUGHAM DR | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660627044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137806320 | ||||||||
| FaxNumber: | 9134691441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1509 W TRUMAN RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640503436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134691488 | ||||||||
| FaxNumber: | 9134691441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | 2005026115 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | F1449 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.