MEDICARE: CHARLES R VEST M.D.

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	174400000X	Specialist	10673	OK

General Provider Information

NPI Number	:	1871700146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES R VEST M.D.

Provider Business Mailing Address
First Line	:	1901 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2816
Country	:	US
Telephone Number	:	580-436-5111
Fax Number	:	580-436-1159

Provider Business Practice Location Address
First Line	:	1901 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2816
Country	:	US
Telephone Number	:	580-436-5111
Fax Number	:	580-436-1159

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JACQUIE C VEST
Credential	:
Telephone Number	:	580-436-5111

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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