Mr Charles Robert Mutch, PA is a
Family Medicine physician based in Ft. Gibson, Oklahoma. Mr Charles Robert Mutch is licensed to practice in Oklahoma (license number 39) and his current practice location is 104 Lone Oak Circle, Ft. Gibson, Oklahoma. He can be reached at his office (for appointments etc.) via phone at
(918) 478-2101.
NPI number for Mr Charles Robert Mutch is 1831206671 and his current mailing address is Po Box 1008, Tahlequah, Oklahoma. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1831206671.
Physician's Profile
| Full Name | Mr Charles Robert Mutch |
|---|
| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 104 Lone Oak Circle, Ft. Gibson, Oklahoma |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1831206671
- Provider Enumeration Date: 08/25/2006
- Last Update Date: 05/13/2010
Medical Identifiers
Medical identifiers for Mr Charles Robert Mutch such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1831206671 | NPI | - | NPPES |
| 100015570A | Medicaid | OK | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 39 (Oklahoma) | Primary |
| 2083X0100X | Preventive Medicine - Occupational Medicine | 39 (Oklahoma) | Secondary |
| 247100000X | Radiologic Technologist | 39 (Oklahoma) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Charles Robert Mutch is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Charles Robert Mutch, PA
Po Box 1008,
Tahlequah, OK 74465-1008
Ph: (918) 478-2101 | Mr Charles Robert Mutch, PA
104 Lone Oak Circle,
Ft. Gibson, OK 74434
Ph: (918) 478-2101 |
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