Provider Demographics
NPI:1427256106
Name:FERRELL, CHARLES WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:FERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:405-853-6100
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1019
Practice Address - Country:US
Practice Address - Phone:405-853-6100
Practice Address - Fax:405-853-4491
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200170160AMedicaid
OK200170160AMedicaid