1730260084 NPI number — CHARLES J ALEXIS M.D

Table of content: CHARLES J ALEXIS M.D (NPI 1730260084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730260084 NPI number — CHARLES J ALEXIS M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXIS
Provider First Name:
CHARLES
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730260084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7348 EDENBOROUGH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73132-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-270-0501
Provider Business Mailing Address Fax Number:
405-290-1887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 NE 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-270-0501
Provider Business Practice Location Address Fax Number:
405-290-1887
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  15773 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77948 . This is a "EMPOYE IDENTIFICATION NUM" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".