Provider Demographics
NPI:1447655923
Name:CHARLES C. WEDDLE, JR PHD, MD, PLLC
Entity type:Organization
Organization Name:CHARLES C. WEDDLE, JR PHD, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-306-6531
Mailing Address - Street 1:8151 E SORGHUM MILL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9526
Mailing Address - Country:US
Mailing Address - Phone:405-306-6531
Mailing Address - Fax:
Practice Address - Street 1:8151 E SORGHUM MILL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9526
Practice Address - Country:US
Practice Address - Phone:405-306-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty