Provider Demographics
NPI:1437344330
Name:VALGORA, CHARLES (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:VALGORA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2101 NORTH 14TH STREET
Mailing Address - Street 2:STE114
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-762-1552
Mailing Address - Fax:580-762-1596
Practice Address - Street 1:2101 N 14TH ST
Practice Address - Street 2:STE114
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1807
Practice Address - Country:US
Practice Address - Phone:580-762-1552
Practice Address - Fax:580-762-1596
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical