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General NPI Number Information
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NPI Number | 1558369892
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Entity Type | Individual
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Provider Name | CHARLES HARWOOD FUNDERBURK JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 9600 BROADWAY EXT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114
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Country | US
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Telephone | 405-230-9000
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Fax | 405-230-9157
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Provider Business Mailing Address
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Address Line | 9600 BROADWAY EXT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-7408
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Country | US
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Telephone | 405-230-9000
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Fax | 405-230-9175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17610
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 17610
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 17610
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License Number State | OK
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