Healthcare Provider Details

I. General information

NPI: 1073047247
Provider Name (Legal Business Name): CHARLES DANIEL MCGUFFEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 330
JACKSON MS
39202-2027
US

IV. Provider business mailing address

608 STANTON L YOUNG BLVD STE 137
OKLAHOMA CITY OK
73104-5065
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-2020
  • Fax:
Mailing address:
  • Phone: 405-271-7816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number37808
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number30056
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: