Individual
DR. CHARLES JOSEPH CHOUTEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1121 NEO LOOP, GROVE, OK 74344-6046
(918) 786-8448
(918) 786-3483
Mailing address
1121 NEO LOOP, GROVE, OK 74344-6046
(918) 786-8448
(918) 786-3483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12203
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0337370001
DME
—
01
—
080029338
RAILROAD MEDICARE
—
05
—
100229210B
—
OK
Enumeration date
07/07/2005
Last updated
03/25/2015
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