Provider Demographics
NPI:1871937847
Name:JANTZEN, CHARLES A (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:JANTZEN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-977-1910
Mailing Address - Fax:580-237-1925
Practice Address - Street 1:915 E GARRIOTT RD
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-977-1910
Practice Address - Fax:580-237-1925
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2017-10-06
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Provider Licenses
StateLicense IDTaxonomies
OK5574207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine