Provider Demographics
NPI:1134189798
Name:JONES, CHARLES K (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:KIM
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-6214
Mailing Address - Country:US
Mailing Address - Phone:405-207-9000
Mailing Address - Fax:405-207-9991
Practice Address - Street 1:1200 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075
Practice Address - Country:US
Practice Address - Phone:405-207-9000
Practice Address - Fax:405-207-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherEIN
OKD42537Medicare UPIN