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Individual

CHARLES STEPHEN PAINE JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3200 S KINGS HWY, CUSHING, OK 74023-5355
(918) 225-3336
Mailing address
8706 W ESECO, AGRA, OK 74824-6208
(918) 285-6344

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01036853
IN
208D00000X
General Practice Physician
Primary
28754
OK

Other

Enumeration date
04/17/2007
Last updated
10/30/2014
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