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NPI Code Detail

MEDICARE: CHARLES DEWAYNE POOR CCP

MEDICARE: CHARLES DEWAYNE POOR CCP
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
1174400000XSpecialistLP 24OK

General Provider Information

NPI Number : 1851402606
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES DEWAYNE POOR CCP
Provider Business Mailing Address
First Line : 3601 N MAY AVE
Second Line : SUITE C
City : OKLAHOMA CITY
State : OK
Zip : 73112-6641
Country : US
Telephone Number : 405-604-5613
Fax Number : 405-601-3750
Provider Business Practice Location Address
First Line : 3601 N MAY AVE
Second Line : SUITE C
City : OKLAHOMA CITY
State : OK
Zip : 73112-6641
Country : US
Telephone Number : 405-604-5613
Fax Number : 405-601-3750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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Directions to “ CHARLES DEWAYNE POOR CCP” Practice Location

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