Provider Demographics
NPI:1407844491
Name:JONES, CHARLES TERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TERRY
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1705 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3041
Mailing Address - Country:US
Mailing Address - Phone:405-285-7500
Mailing Address - Fax:405-285-7501
Practice Address - Street 1:7807 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9470
Practice Address - Country:US
Practice Address - Phone:405-636-0767
Practice Address - Fax:405-636-0353
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK245433801Medicare ID - Type Unspecified
OKE26924Medicare UPIN