Provider Demographics
NPI:1063838639
Name:WILSON, CHARLES LLOYD (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LLOYD
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5200 E I 240 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2607
Mailing Address - Country:US
Mailing Address - Phone:405-416-9701
Mailing Address - Fax:405-416-9730
Practice Address - Street 1:MERCY SOUTH
Practice Address - Street 2:5200 E I-240 SERVICE ROAD
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135
Practice Address - Country:US
Practice Address - Phone:405-416-9701
Practice Address - Fax:405-416-9730
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK140226208M00000X
OK5836208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist