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General NPI Number Information
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NPI Number | 1942446414
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Entity Type | Organization
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Legal Business Name | CHARLES LEVESQUE PA-C, INC.
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 1776 N SCOTTSDALE RD UNIT 368
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City | SCOTTSDALE
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State | AZ
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Zip | 85252
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Country | US
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Telephone | 480-201-5264
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | SCOTTSDALE
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State | AZ
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Zip | 85252-0368
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Country | US
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Telephone | 480-201-5264
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Fax | 480-393-1970
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES LAURENT LEVESQUE
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Credential | PA-C
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Telephone | 480-299-4603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1621
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License Number State | AZ
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