Basic Information
| Provider Information | |||||||||
| NPI: | 1013124031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODMAN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11311 S KINGSTON AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741377734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182967171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CLAREMORE REGIONAL HOSPITAL | ||||||||
| Address2: | 1415 N. MUSKOGEE PL | ||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183412556 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4328 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.