Organization
ADA ORTHOPEDICS & SPORTS MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER JOHN CHARBONEAU D.O. (SURGEON)
(580) 332-4443
Entity
Organization
Contact information
Practice address
625 N MONTE VISTA ST, ADA, OK 74820-4613
(580) 332-4443
(580) 332-4846
Mailing address
625 N MONTE VISTA ST, ADA, OK 74820-4613
(580) 332-4443
(580) 332-4846
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD1743
RAILROAD MEDICARE
OK
Enumeration date
02/01/2007
Last updated
03/27/2008
Update your record
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