Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 20629 | OK |
NPI | 1326063017 |
---|---|
Provider Name | Dr. Charles Paul Mirabile JR. |
First Address | Oklahoma City, OK 73120-8300 |
Second Address | Oklahoma City, OK 73120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 10/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100821300A | (05) | OK |
G48086 | (02) |