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General NPI Number Information
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NPI Number | 1700873221
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Entity Type | Individual
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Provider Name | CHARLES ANTHONY SHURLOW D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 2510 5TH ST BLDG 840, AREA B
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City | WRIGHT PATTERSON AFB
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State | OH
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Zip | 45433-7951
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Country | US
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Telephone | 937-938-2736
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Fax | 937-656-4006
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Provider Business Mailing Address
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Address Line | 2510 5TH ST BLDG 840, AREA B
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City | WRIGHT PATTERSON AFB
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State | OH
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Zip | 45433-7951
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Country | US
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Telephone | 937-938-2736
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Fax | 937-656-4006
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101010571
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101010571
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.009947
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License Number State | OH
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