Provider Demographics
NPI:1831198894
Name:OGLE, CHARLES MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:OGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:C
Other - Middle Name:MICHAEL
Other - Last Name:OGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-1467
Mailing Address - Country:US
Mailing Address - Phone:580-338-2637
Mailing Address - Fax:580-338-2652
Practice Address - Street 1:400 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942
Practice Address - Country:US
Practice Address - Phone:580-338-2637
Practice Address - Fax:580-338-2652
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2645207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101750AMedicaid
OK100101750BMedicaid
OK100101750BMedicaid
OK$$$$$$$$$PMedicare PIN
OK100101750AMedicaid
OK247226702Medicare PIN