Active NPI
Charles Joseph Wine, M.D.
- Otolaryngology Physician
- Tahlequah, OK
National Provider Identifier
1740403088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 9465
- Practice address
- 100 S Bliss Ave
Tahlequah, OK 74464-2512 - Phone
- (918) 458-3360
- Fax
- (918) 458-3511
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 9465 | OK | Primary |
Addresses
Primary practice location
100 S Bliss Ave
Tahlequah, OK 74464-2512
Mailing address
3117 Hickory Stick Rd
Oklahoma City, OK 73120-6001
Phone (405) 751-9274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9465 | OK | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1740403088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3117 HICKORY STICK RD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731206001",
"telephone_number": "405-751-9274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S BLISS AVE",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744642512",
"telephone_number": "918-458-3360",
"fax_number": "918-458-3511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINE",
"first_name": "CHARLES",
"middle_name": "JOSEPH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "OK",
"license": "9465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.