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1891757860
CHARLES DEWAYNE BLACK
ARDMORE, OK
NPI
1891757860
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207PE0004X Emergency Medicine, Emergency Medical Services
(Licence: OK 3023)
Enumeration Date
2006-04-05
Last Update Date
2007-11-09
Business Address
-- CHARLES DEWAYNE BLACK D.O.
1011 14TH AVE NW ER DEPT.
ARDMORE, OK 73401-1828
Phone number: 580-220-6415
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Mailing Address
-- CHARLES DEWAYNE BLACK D.O.
4401 W MEMORIAL RD SUITE 121
OKLAHOMA CITY, OK 73134-1785
Phone number: 405-751-4664
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