Charboneau, Roger John
Charboneau, Roger John is an sole proprietor health care provider with primary practice located at 1921 Stonecipher Dr , Ada OK 74820-3439. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Charboneau, Roger John can be contacted via phone (580) 559-0510.Contact Information
Primary practice address
1921 Stonecipher Dr
Ada OK 74820-3439
Phone: (580) 559-0510
Fax: (580) 272-2715
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Sports Medicine | 207XX0005X | 4037 | Oklahoma |
Profile Details
| NPI number | 1609862689 |
|---|---|
| LBN Legal business name | Charboneau, Roger John |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 23rd, 2005 |
| Last updated | Aug 10th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609862689 | NPPES |
| Oklahoma | MEDICAID | 200009440A | |
| Oklahoma | Other | 611692300 | |
| Oklahoma | Other | P00212246 |
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