Healthcare Provider Details

I. General information

NPI: 1487647962
Provider Name (Legal Business Name): CHARLES THOMAS WEEKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 NW 12TH DR
PENDLETON OR
97801-1268
US

IV. Provider business mailing address

1048 NW 12TH DR
PENDLETON OR
97801-1268
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4152
  • Fax:
Mailing address:
  • Phone: 541-276-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD11123
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: