Individual
CHARLES R CANTRELL
Active
Individual
CHARLES R CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R2P09
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100195170A
—
OK
05
—
1568438307
—
MO
05
—
202311003
—
AR
05
—
243037579
—
MO
01
—
P00199788
RR MEDICARE
—
Enumeration date
02/23/2006
Last updated
12/22/2020
Update your record
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