Provider Demographics
NPI:1013979335
Name:HILL, CHARLES HAYWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HAYWARD
Last Name:HILL
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 1:5330 E 31ST ST STE 800
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5004
Mailing Address - Country:US
Mailing Address - Phone:918-664-9000
Mailing Address - Fax:918-664-9922
Practice Address - Street 1:5330 E 31ST ST STE 800
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5004
Practice Address - Country:US
Practice Address - Phone:918-664-9000
Practice Address - Fax:918-664-9922
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK164842084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095570AMedicaid
OKE95683Medicare UPIN