=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447220538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD WILLIAM CHARLES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 10/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1610 W TOWNLINE ST
-----------------------------------------------------
City | CRESTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50801-1066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-782-3887
-----------------------------------------------------
Fax | 641-782-3504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 W TOWNLINE ST
-----------------------------------------------------
City | CRESTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50801-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-782-7091
-----------------------------------------------------
Fax | 641-782-3830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 27934
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------