Individual
CHARLES HARWOOD FUNDERBURK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9600 BROADWAY EXT, OKLAHOMA CITY, OK 73114
(405) 230-9000
(405) 230-9157
Mailing address
9600 BROADWAY EXT, OKLAHOMA CITY, OK 73114-7408
(405) 230-9000
(405) 230-9175
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
17610
OK
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
17610
OK
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
17610
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100034390A
—
OK
01
—
200040194
RAILROAD MEDICARE
OK
Enumeration date
07/11/2005
Last updated
08/09/2019
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