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General NPI Number Information
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NPI Number | 1528251956
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Entity Type | Individual
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Provider Name | CHARLES STEPHEN GINN DPM
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Gender | Male
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 5203 S 45TH ST
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City | ROGERS
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State | AR
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Zip | 72758-8854
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Country | US
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Telephone | 479-531-7416
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Fax | 888-371-5937
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Provider Business Mailing Address
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Address Line | 5203 S 45TH ST
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City | ROGERS
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State | AR
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Zip | 72758-8854
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Country | US
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Telephone | 479-531-7416
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Fax | 888-371-5937
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 243
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2007022315
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License Number State | MO
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