Individual
CHARLES JOSEPH WINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3360
(918) 458-3511
Mailing address
3117 HICKORY STICK RD, OKLAHOMA CITY, OK 73120-6001
(405) 751-9274
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
9465
OK
Other
Enumeration date
04/11/2007
Last updated
07/09/2007
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