Individual
DR. ROGER JOHN CHARBONEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 559-0510
(580) 272-2715
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 559-0510
(580) 272-2715
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
4037
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200009440A
—
OK
01
—
611692300
OWCP
OK
01
—
P00212246
RAILROAD MEDICARE
OK
Enumeration date
09/23/2005
Last updated
08/10/2016
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