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General NPI Number Information
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NPI Number | 1639168735
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Entity Type | Individual
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Provider Name | CHARLES DEWEY MCMAHON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3245 INTERNATIONAL CIR STE 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3152
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Country | US
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Telephone | 719-633-8000
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Fax | 719-434-8855
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | COLORADO SPRINGS
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State | CO
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Zip | 80901-0280
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Country | US
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Telephone | 719-440-0058
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Fax | 719-434-8855
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | DR.0018837
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License Number State | CO
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