Mutch, Charles Robert

Mutch, Charles Robert is an individual health care provider with primary practice located at 104 Lone Oak Circle , Ft. Gibson OK 74434. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Occupational Medicine, Technologists, Technicians & Other Technical Service Providers / Radiologic Technologist. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Mutch, Charles Robert can be contacted via phone (918) 478-2101.

Contact Information

Primary practice address
104 Lone Oak Circle Ft. Gibson OK 74434
Phone: (918) 478-2101
Fax: (918) 478-6008
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 39 Oklahoma
Allopathic & Osteopathic Physicians / Occupational Medicine 2083X0100X 39 Oklahoma
Technologists, Technicians & Other Technical Service Providers / Radiologic Technologist 247100000X 39 Oklahoma

Profile Details

NPI number 1831206671
LBN Legal business name Mutch, Charles Robert
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2006
Last updated May 13th, 2010 - about 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831206671 NPPES
Oklahoma MEDICAID 100015570A

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