Provider Demographics
NPI:1770126625
Name:WHITERS, CHARLES JOE EDWARD
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOE EDWARD
Last Name:WHITERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7611
Mailing Address - Country:US
Mailing Address - Phone:405-301-7653
Mailing Address - Fax:
Practice Address - Street 1:201 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7611
Practice Address - Country:US
Practice Address - Phone:405-301-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist