MEDICARE: CHARLES R FLAKE MD

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
1	207V00000X	Obstetrics & Gynecology Physician	MD00020623	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	F415	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1548373814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES R FLAKE MD

Provider Business Mailing Address
First Line	:	3003 ISLAND CREST WAY
Second Line	:
City	:	MERCER IS
State	:	WA
Zip	:	98040
Country	:	US
Telephone Number	:	206-232-5400
Fax Number	:	206-232-9179

Provider Business Practice Location Address
First Line	:	3003 ISLAND CREST WAY
Second Line	:
City	:	MERCER IS
State	:	WA
Zip	:	98040
Country	:	US
Telephone Number	:	206-232-5400
Fax Number	:	206-232-9179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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