Provider Demographics
NPI:1629014899
Name:VANTUYL, CHARLES DON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DON
Last Name:VANTUYL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1306 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7237
Mailing Address - Country:US
Mailing Address - Phone:918-429-9355
Mailing Address - Fax:
Practice Address - Street 1:11911 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2030
Practice Address - Country:US
Practice Address - Phone:918-943-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK165352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE58199Medicare UPIN