Individual
CHARLES MICHAEL WORSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
6100 S YALE BLVD, C/O EMP, TULSA, OK 74129-5101
(918) 502-3939
Mailing address
PO BOX 22063, DEPT 0289, TULSA, OK 74121-2063
(405) 751-4664
(405) 749-4561
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
570
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100165960A
—
OK
01
—
970019450
RR MEDICARE
OK
Enumeration date
04/28/2006
Last updated
05/01/2008
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