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General NPI Number Information
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NPI Number | 1275619603
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Entity Type | Individual
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Provider Name | CHARLES CODY CULL DPM
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 1717 NAVAJO LAKE WAY
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City | LAS VEGAS
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State | NV
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Zip | 89128-3283
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Country | US
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Telephone | 702-596-5589
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Fax | 725-205-4844
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Provider Business Mailing Address
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Address Line | 1717 NAVAJO LAKE WAY
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City | LAS VEGAS
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State | NV
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Zip | 89128-3283
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Country | US
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Telephone | 702-596-5589
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Fax | 725-205-4844
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1201
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000745A
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License Number State | IN
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