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General NPI Number Information
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NPI Number | 1265501274
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Entity Type | Organization
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Legal Business Name | FAMILY CARE SPEC, INC., P.C.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 601 E 13TH ST STE C
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City | GROVE
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State | OK
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Zip | 74344-2962
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Country | US
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Telephone | 918-786-6151
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Fax | 918-786-3483
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Provider Business Mailing Address
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Address Line | 601 E 13TH ST STE C
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City | GROVE
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State | OK
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Zip | 74344-2962
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Country | US
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Telephone | 918-786-6151
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Fax | 918-786-3483
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES JOSEPH CHOUTEAU
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Credential | MD
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Telephone | 918-786-6151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12203
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License Number State | OK
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