MEDICARE: CHARLES A MCWILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	11817	OK

General Provider Information

NPI Number	:	1336226687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A MCWILLIAMS MD

Provider Business Mailing Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE 1007
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-752-1414
Fax Number	:	405-752-1744

Provider Business Practice Location Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE 1007
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-752-1414
Fax Number	:	405-752-1744

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	CHARLES A MCWILLIAMS
Credential	:	MD
Telephone Number	:	405-752-1414

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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