MR. CHARLES ROBERT MUTCH (NPI# 1831206671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831206671 |
| Entity Type | Individual |
| Full Name | MR. CHARLES ROBERT MUTCH |
| Credential | PA |
| Practice Address |
104 Lone Oak Circle Ft. Gibson OK 74434 |
| Mailing Address |
Po Box 1008 Tahlequah OK 74465-1008 |
| Practice Telephone | 9184782101 |
| Practice Fax Number | 9184786008 |
| Mailing Telephone | 9184782101 |
| Mailing Fax Number | 9184786008 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-05-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 39 | OK | Allopathic & Osteopathic Physicians |
| N | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
39 | OK | Allopathic & Osteopathic Physicians |
| N | 247100000X | Radiologic Technologist | 39 | OK | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100015570A | 05 |
| Street Address |
104 LONE OAK CIRCLE |
| City | FT. GIBSON |
| State | OK |
| Zip Code | 74434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790892529 | Donald M Elgin | Family Medicine | 104 Lone Oak Circle, Ft. Gibson, OK 74434 | 2006-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326323296 | Janet Hulbert | Occupational Therapist | 1409 Saddlebrooke Dr, Fort Gibson, OK 74434 | 2011-10-11 |
| 1356643936 | Justin Matthew Wedman | Pharmacist | 114 N. Lee St., Fort Gibson, OK 74434 | 2010-12-02 |
| 1396980546 | Walker & Walker P.l.l.c. | Dentist | 106 Lone Oak Cr, Ft. Gibson, OK 74434 | 2008-12-02 |
| 1548305857 | Christopher Back | Family Medicine | 129 N Lee St., Fort Gibson, OK 74434 | 2007-02-21 |
| 1982794442 | Wanda Ann Teague | Speech-Language Pathologist | 500 South Ross Ave., Fort Gibson, OK 74434 | 2006-10-13 |
| 1891898912 | Scotts Pharmacy LLC | Pharmacy | 1201 S Lee St, Fort Gibson, OK 74434 | 2006-09-06 |
| 1073511184 | Brandon Medical, LLC | Prosthetic/Orthotic Supplier | 110 North Lee Street, Fort Gibson, OK 74434 | 2005-07-12 |
| 1265761381 | Holly Jean Dawson | Obstetrics & Gynecology | 108 Lone Oak Cir, Fort Gibson, OK 74434 | 2009-12-19 |
| 1942352919 | Frank J Evans | Dentist | 802 S Lee, Fort Gibson, OK 74434-0206 | 2007-01-18 |
| 1811180664 | Marvin Moul | Internal Medicine | 104 Lone Oak Cir, Fort Gibson, OK 74434-5001 | 2007-08-24 |
| Find all providers in zip 74434 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790892529 | Donald M Elgin | Family Medicine | 104 Lone Oak Circle, Ft. Gibson, OK 74434 | 2006-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447172 | Saints Medical Group, LLC | Family Medicine | 2749 Progressive Dr, Suite B, Edmond, OK 73034 | 2020-11-06 |
| 1346841673 | Nugenex Plus Aprn-cnp Pllc | Family Medicine | 13425 Deer Spring Dr, Piedmont, OK 73078-3001 | 2020-11-03 |
| 1235739764 | Pinnacle Family Health Care | Family Medicine | 2781 Washington Drive, Suite 101, Norman, OK 73069 | 2020-10-26 |
| 1548868573 | Kayla Lynn Birchfield | Family Medicine | 220 W Jackson St, Crescent, OK 73028-8908 | 2020-10-12 |
| 1164039632 | Axiom Medical Solutions, LLC | Family Medicine | 14132 Se 134th St, Oklahoma City, OK 73165-7669 | 2020-09-28 |
| 1174139554 | Crestcare Family Medicine,pllc | Family Medicine | 817 S Elm Pl Ste 104, Broken Arrow, OK 74012-5369 | 2020-09-21 |
| 1346855640 | Charger Health Group Pllc | Family Medicine | 511 N Aspen Ave, Broken Arrow, OK 74012-2220 | 2020-09-14 |
| 1952916645 | Brandi Suzanne Shell | Family Medicine | 26471 E 141st St S, Coweta, OK 74429-5517 | 2020-09-10 |
| 1730793696 | Osumc Professional Services LLC | Family Medicine | 112 W 5th Street, Okmulgee, OK 74447-0000 | 2020-09-08 |
| 1104437219 | L and M Investments LLC | Family Medicine | 6001 Nw 139th St, Oklahoma City, OK 73142-1919 | 2020-08-12 |
| Find all providers with the same taxonomy | ||||
| City | FT. GIBSON |
| Zip Code | 74434 |
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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.