Provider Demographics
NPI:1124208657
Name:CHARLES N. HOWARD, JR., M.D., INC.
Entity Type:Organization
Organization Name:CHARLES N. HOWARD, JR., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:405-238-9343
Mailing Address - Street 1:415 W GUY AVE
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-3200
Mailing Address - Country:US
Mailing Address - Phone:405-238-9343
Mailing Address - Fax:405-238-9346
Practice Address - Street 1:415 W GUY AVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3200
Practice Address - Country:US
Practice Address - Phone:405-238-9343
Practice Address - Fax:405-238-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11375208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10093620AMedicaid
OKD34825Medicare UPIN