Healthcare Provider Details

I. General information

NPI: 1881667145
Provider Name (Legal Business Name): CHARLES P HUNDLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 NW EDENBOWER BLVD SUITE 100
ROSEBURG OR
97470-6220
US

IV. Provider business mailing address

2570 NW EDENBOWER BLVD STE 100
ROSEBURG OR
97471-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-7200
  • Fax: 541-229-3363
Mailing address:
  • Phone: 541-677-7200
  • Fax: 541-229-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO18800
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: