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NPI Code Detail

MEDICARE: CHARLES A ANDERSON CP

MEDICARE: CHARLES A ANDERSON CP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224P00000XProsthetistLP11OK

General Provider Information

NPI Number : 1720225477
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES A ANDERSON CP
Provider Business Mailing Address
First Line : 4301 N CLASSEN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-5031
Country : US
Telephone Number : 405-525-4000
Fax Number : 405-530-3670
Provider Business Practice Location Address
First Line : 4301 N CLASSEN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-5031
Country : US
Telephone Number : 405-525-4000
Fax Number : 405-530-3670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2009
Last Update Date : 01/16/2009

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Directions to “ CHARLES A ANDERSON CP” Practice Location

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