Healthcare Provider Details

I. General information

NPI: 1598862013
Provider Name (Legal Business Name): DAVID M CHARLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 HUMBOLDT ST
DENVER CO
80218-1638
US

IV. Provider business mailing address

1578 HUMBOLDT ST
DENVER CO
80218-1638
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-7200
  • Fax: 303-830-7523
Mailing address:
  • Phone: 303-830-7200
  • Fax: 303-830-7523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20887
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: