Provider Demographics
NPI:1225689979
Name:INES, CHARLES V
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:V
Last Name:INES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHAZ
Other - Middle Name:
Other - Last Name:INEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3160 N STATE HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-8336
Mailing Address - Country:US
Mailing Address - Phone:918-236-9411
Mailing Address - Fax:918-600-1661
Practice Address - Street 1:3160 N STATE HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-8336
Practice Address - Country:US
Practice Address - Phone:918-236-9411
Practice Address - Fax:918-600-1661
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver