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Individual

CHARLES DEWAYNE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1011 14TH AVE NW, ER DEPT., ARDMORE, OK 73401-1828
(580) 220-6415
(405) 749-4561
Mailing address
4401 W MEMORIAL RD, SUITE 121, OKLAHOMA CITY, OK 73134-1785
(405) 751-4664
(405) 749-4561

Taxonomy

Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
3023
OK

Other

Enumeration date
04/05/2006
Last updated
11/09/2007
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