Healthcare Provider Details

I. General information

NPI: 1275537540
Provider Name (Legal Business Name): CHARLES W RANSLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KENTUCKY AVE STE 102
PADUCAH KY
42003-3815
US

IV. Provider business mailing address

2605 KENTUCKY AVE SUITE 306
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-3554
  • Fax: 270-442-2051
Mailing address:
  • Phone: 270-415-7653
  • Fax: 270-575-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number22524
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: