Healthcare Provider Details

I. General information

NPI: 1861494015
Provider Name (Legal Business Name): CHARLES M GELNAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BRYANT AVE #104
EDMOND OK
73034-6330
US

IV. Provider business mailing address

4900 S. MONACO ST SUITE 210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-0956
  • Fax: 405-216-7582
Mailing address:
  • Phone: 405-216-0956
  • Fax: 405-216-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9295
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: