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NPI Code Detail

MEDICARE: MR. CHARLES JOSEPH PARADISE CRNA

MEDICARE: MR. CHARLES JOSEPH PARADISE CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist691160TX
2367500000XCertified Registered Nurse Anesthetist202002199CRNAOR

General Provider Information

NPI Number : 1063402634
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES JOSEPH PARADISE CRNA
Provider Business Mailing Address
First Line : 1333 E BARNETT RD
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8219
Country : US
Telephone Number : 361-883-6211
Fax Number : 361-882-4891
Provider Business Practice Location Address
First Line : 1333 E BARNETT RD
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8219
Country : US
Telephone Number : 541-779-4711
Fax Number : 541-779-0796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 07/31/2020

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Directions to “ MR. CHARLES JOSEPH PARADISE CRNA” Practice Location

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