Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25661 | OK |
N | 111NI0900X | Internist | 25661 | OK |
N | 207RC0000X | Internist - Cardiovascular Disease | 25661 | OK |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 25661 | OK |
NPI | 1285830760 |
---|---|
Provider Name | Charles Carvajal Te |
First Address | Oklahoma City, OK 73132-3385 |
Second Address | Oklahoma City, OK 73120-8382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200192780A | (05) | OK |