Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4328 | OK |
NPI | 1013124031 |
---|---|
Provider Name | Dr. Charles Allen Rodman IV |
First Address | Tulsa, OK 74137-7734 |
Second Address | Claremore, OK 74017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |