Organization
CNS SURGERY INC
Active
Organization
CNS SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BERRY FULLENWIDER M.D. (PRESIDENT)
(918) 682-8087
Entity
Organization
Contact information
Practice address
333 S 38TH ST STE F, MUSKOGEE, OK 74401-4937
(918) 682-8087
(918) 682-6449
Mailing address
333 S 38TH ST STE F, MUSKOGEE, OK 74401-4937
(918) 682-8087
(918) 682-6449
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
12300
OK
Other
Enumeration date
12/05/2006
Last updated
08/22/2020
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