Individual
CHARLES M FOFANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1122 NE 13TH ST, OKLAHOMA CITY, OK 73117-1039
(405) 271-4351
(405) 271-8695
Mailing address
PO BOX 26901, OKLAHOMA CITY, OK 73126-0901
(405) 271-4351
(405) 271-8695
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F10170079
OK
Other
Enumeration date
10/04/2017
Last updated
01/25/2021
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