Provider Demographics
NPI:1679751689
Name:FUTRELL, CHARLES HULETT JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HULETT
Last Name:FUTRELL
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1079
Mailing Address - Country:US
Mailing Address - Phone:270-827-0353
Mailing Address - Fax:270-827-4966
Practice Address - Street 1:110 3RD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2993
Practice Address - Country:US
Practice Address - Phone:270-826-3440
Practice Address - Fax:270-827-8798
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2013-03-12
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Provider Licenses
StateLicense IDTaxonomies
KY03076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100036260Medicaid
KY00690001Medicare PIN