Healthcare Provider Details

I. General information

NPI: 1730260084
Provider Name (Legal Business Name): CHARLES J ALEXIS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

7348 EDENBOROUGH DR
OKLAHOMA CITY OK
73132-5616
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax: 405-290-1887
Mailing address:
  • Phone: 405-270-0501
  • Fax: 405-290-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number15773
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: