Healthcare Provider Details

I. General information

NPI: 1821097973
Provider Name (Legal Business Name): EDWARD H CHARLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD SUITE E265
GLENDALE AZ
85306-4641
US

IV. Provider business mailing address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-8317
  • Fax: 602-843-9091
Mailing address:
  • Phone: 602-258-9900
  • Fax: 602-258-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27117
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: