Provider Demographics
NPI:1710960240
Name:ENGLES, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:ENGLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268946
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8946
Mailing Address - Country:US
Mailing Address - Phone:405-329-3149
Mailing Address - Fax:405-329-2987
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:STE 208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9322
Practice Address - Country:US
Practice Address - Phone:405-755-3540
Practice Address - Fax:405-755-7001
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123940AMedicaid
OKC94899Medicare UPIN
OK100123940AMedicaid