Provider Demographics
NPI:1609874346
Name:CHOUTEAU, CHARLES JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:CHOUTEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1121 NEO LOOP
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6046
Mailing Address - Country:US
Mailing Address - Phone:918-786-8448
Mailing Address - Fax:918-786-3483
Practice Address - Street 1:1121 NEO LOOP
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-6046
Practice Address - Country:US
Practice Address - Phone:918-786-8448
Practice Address - Fax:918-786-3483
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100229210BMedicaid
0337370001OtherDME
080029338OtherRAILROAD MEDICARE
$$$$$$$$$Medicare PIN
OK100229210BMedicaid