Provider Demographics
NPI:1649493651
Name:POOLE, EDWARD CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:POOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5200 WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8625
Mailing Address - Country:US
Mailing Address - Phone:405-341-7726
Mailing Address - Fax:405-341-9542
Practice Address - Street 1:840 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3616
Practice Address - Country:US
Practice Address - Phone:405-290-4338
Practice Address - Fax:405-290-4082
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19242207ZP0102X
NC121750207ZP0102X
GA055686207ZP0102X
KS04-23181207ZP0102X
LAMD.15611R207ZP0102X
TXL8164207ZP0102X
CAG86104207ZP0102X
CT040814207ZP0102X
NY222739-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology