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NPI Code Detail

MEDICARE: DR. CHARLES WILLIAM HAVERTY DO

MEDICARE: DR. CHARLES WILLIAM HAVERTY DO
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
12084P0800XPsychiatry PhysicianDR.0072681CO

General Provider Information

NPI Number : 1578022612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES WILLIAM HAVERTY DO
Provider Business Mailing Address
First Line : 5350 TOMAH DR STE 3600
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-6991
Country : US
Telephone Number : 970-893-9550
Fax Number :
Provider Business Practice Location Address
First Line : 5350 TOMAH DR STE 3600
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-6991
Country : US
Telephone Number : 970-893-9550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2019
Last Update Date : 10/03/2024

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