Provider Demographics
NPI:1073570578
Name:MCWILLIAMS, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14101 N EASTERN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5859
Mailing Address - Country:US
Mailing Address - Phone:405-340-1279
Mailing Address - Fax:405-340-1605
Practice Address - Street 1:14101 N EASTERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5859
Practice Address - Country:US
Practice Address - Phone:405-340-1279
Practice Address - Fax:405-340-1605
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11817208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100110720AMedicaid
202130641013OtherBC/BS
OK242710701Medicare PIN
OK100110720AMedicaid
OKD35029Medicare UPIN
OK5390430008Medicare NSC