Healthcare Provider Details

I. General information

NPI: 1144206251
Provider Name (Legal Business Name): CHARLES V STARGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N ALLISON AVE
BARBOURVILLE KY
40906-1336
US

IV. Provider business mailing address

PO BOX 1150
BARBOURVILLE KY
40906-5150
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-9287
  • Fax: 606-546-9363
Mailing address:
  • Phone: 606-546-9287
  • Fax: 606-546-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33502
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33502
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: