DR. CHARLES BERRY FULLENWIDER (NPI# 1447245063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447245063 |
| Entity Type | Individual |
| Full Name | DR. CHARLES BERRY FULLENWIDER |
| Credential | M.D. |
| Practice Address |
333 S 38th St Suite F Muskogee OK 74401-4937 |
| Practice Telephone | 9186828087 |
| Practice Fax Number | 9186826449 |
| Mailing Telephone | 9186828087 |
| Mailing Fax Number | 9186826449 |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2008-02-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | 12300 | OK | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417299298 | Charles Fullenwider | General Practice | 8901 Rockville Pike, Bethesda, MD 20889-0001 | 2013-03-20 |
| Street Address |
333 S 38TH ST SUITE F |
| City | MUSKOGEE |
| State | OK |
| Zip Code | 74401-4937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063719730 | Erin Goss | Counselor | 333 S 38th St, Suite K, Muskogee, OK 74401-4937 | 2011-02-16 |
| 1992034292 | David J. Lester, M.d. Inc | Internal Medicine | 333 S 38th St, Suite A, Muskogee, OK 74401-4937 | 2009-12-15 |
| 1346577343 | Jay Gregory, M.d., Inc. P.C. | Surgery | 333 S 38th St, Suite D, Muskogee, OK 74401-4937 | 2009-11-11 |
| 1366562779 | Talat Tawaklna | Internal Medicine | 333 S 38th St, Suite B, Muskogee, OK 74401-4937 | 2007-03-30 |
| 1831273218 | C William Lutton Md PC | Psychiatry & Neurology | 333 S 38th St, Suite H, Muskogee, OK 74401-4937 | 2006-10-24 |
| 1164433157 | Bevan Todd Graybill | Psychologist | 333 S 38th St, Suite K, Muskogee, OK 74401-4937 | 2006-08-11 |
| 1942211958 | B. Todd Graybill, Ph.d., P.l.l.c. | Psychologist | 333 S 38th St, Suite K, Muskogee, OK 74401-4937 | 2006-08-11 |
| 1336102151 | David J Lester | Internal Medicine | 333 S 38th St, Suite A, Muskogee, OK 74401-4937 | 2006-04-11 |
| 1013979061 | Ken Kuykendall | Internal Medicine | 333 S 38th St, Muskogee, OK 74401-4937 | 2006-04-05 |
| 1043288194 | Naga Manohar Javvaji | Internal Medicine | 333 S 38th St, Suite A, Muskogee, OK 74401 | 2006-03-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508486978 | Economy Pharmacy | Pharmacy | 3414 W. Okmulgee, Muskogee, OK 74401 | 2020-04-25 |
| 1831678390 | Jaclyn Drass | Nurse Practitioner | 201 N 32nd St, Muskogee, OK 74401 | 2018-08-07 |
| 1225530710 | Cliffetta J Harrison | Case Management | 619 N Main St., Muskogee, OK 74401 | 2018-03-01 |
| 1255700720 | Wesley B Higgs | Physical Therapist | 151 Eco-friendly Drive, Suite 101, Muskogee, OK 74401 | 2015-09-15 |
| 1699163626 | Dependable Medical Diagnostics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 122 S. 38th, Muskoqee, OK 74401 | 2014-12-29 |
| 1134529928 | Mednow Urgent Care Center LLC | Clinic/Center | 550 W Shawnee St, Muskogee, OK 74401 | 2014-08-28 |
| 1447676770 | Ruby Johns | Counselor | 403 N 24th, Muskogee, OK 74401 | 2014-03-11 |
| 1417393380 | Andreka Pace | Counselor | 223 W Southside Boulevard, Muskogee, OK 74401 | 2013-05-17 |
| 1730438342 | Gordon Keith Harlin | Social Worker | 619 N Main, Muskogee, OK 74401 | 2012-08-29 |
| 1740565928 | Channing Kathleen Burke | Counselor | 741 South 32nd Street, Muskogee, OK 74401 | 2011-10-19 |
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| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396803060 | Cns Surgery Inc | Neurological Surgery | 333 S 38th St Ste F, Muskogee, OK 74401-4937 | 2006-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114560554 | Secure Interpretation, LLC | Neurological Surgery | 5561 South Lewis Ave, Tulsa, OK 74105 | 2019-10-17 |
| 1710540257 | David M Mckalip Md Pllc | Neurological Surgery | 5108 W Gore Blvd Ste 2b, Lawton, OK 73505-6025 | 2019-04-19 |
| 1215356589 | Zoya Alexandrovna Voronovich | Neurological Surgery | 1000 N Lincoln Blvd Ste 300, Oklahoma City, OK 73104-3252 | 2014-04-15 |
| 1588912034 | Carrissa Candler Md Pllc | Neurological Surgery | 120 N Bryant Ave Ste A6, Edmond, OK 73034-6300 | 2012-08-15 |
| 1396034047 | Saints Medical Group, LLC | Neurological Surgery | 800 Nw 9th St Ste 201, Oklahoma City, OK 73106-7253 | 2011-04-04 |
| 1669784351 | Thomas D. Reeder II, D.o., P.C. | Neurological Surgery | 2212 Nw 47th St, Oklahoma City, OK 73112-8848 | 2010-07-09 |
| 1215252440 | Joanna Elizabeth Gernsback | Neurological Surgery | 1000 N Lincoln Blvd # 4000, Oklahoma City, OK 73104-3252 | 2010-03-31 |
| 1811222094 | John Albert Coates | Neurological Surgery | 6416 S Quebec Ave, Tulsa, OK 74136-1611 | 2009-10-06 |
| 1003050493 | Tyler Sean Auschwitz | Neurological Surgery | 2000 South Wheeling, Ste 200, St. Johns Neuroscience Institute, Tulsa, OK 74104 | 2009-04-29 |
| 1881867547 | Rongsheng Cai | Neurological Surgery | 6151 S Yale Ave Ste 2403, Tulsa, OK 74136-1907 | 2008-04-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.