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General NPI Number Information
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NPI Number | 1225016009
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Entity Type | Individual
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Provider Name | CHARLES B VERNON MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 1791 HIGHWAY 64 E
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City | ANAMOSA
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State | IA
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Zip | 52205-2112
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Country | US
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Telephone | 319-462-3571
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Fax | 319-462-6043
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Provider Business Mailing Address
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Address Line | 1791 HIGHWAY 64 E
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City | ANAMOSA
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State | IA
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Zip | 52205-2112
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Country | US
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Telephone | 319-462-3571
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Fax | 319-462-6043
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24257
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 24257
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License Number State | IA
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