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1134123821

NPI Code Detail

MEDICARE: KERRI M CHARLES M.D.

MEDICARE: KERRI M CHARLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD183947	OR
2	207Q00000X	Family Medicine Physician	150529	CA
3	207Q00000X	Family Medicine Physician	11433A	WY
4	207Q00000X	Family Medicine Physician	ME133313	FL
5	207Q00000X	Family Medicine Physician	M-13888	ID
6	207Q00000X	Family Medicine Physician	MD60771851	WA
7	207Q00000X	Family Medicine Physician	MED-PHYS-LIC-59836	MT
8	207Q00000X	Family Medicine Physician	124688	AK
9	207Q00000X	Family Medicine Physician	54999	AZ
10	207Q00000X	Family Medicine Physician	MD-19398	HI
11	207Q00000X	Family Medicine Physician	MD2017-0960	NM
12	207Q00000X	Family Medicine Physician	17595	NV
13	207Q00000X	Family Medicine Physician	L6320	TX
14	207Q00000X	Family Medicine Physician	46230	CO
15	207Q00000X	Family Medicine Physician	CDRH.0046230	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134123821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI M CHARLES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9049
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-9049
Country	:	US
Telephone Number	:	303-415-4101
Fax Number	:	303-415-4769

Provider Business Practice Location Address
First Line	:	1000 W SOUTH BOULDER RD STE 110
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2753
Country	:	US
Telephone Number	:	303-415-4355
Fax Number	:	303-666-1982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/24/2025

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Directions to “ KERRI M CHARLES M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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