MEDICARE: CHARLES MILTON COMBS III FNP

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	363LF0000X	Family Nurse Practitioner	240573	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TEMP240573	OTHER	AZ	STATE ISSUED LICENSE

General Provider Information

NPI Number	:	1659991461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MILTON COMBS III FNP

Provider Business Mailing Address
First Line	:	3035 E VERNON ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-8757
Country	:	US
Telephone Number	:	480-522-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 E VERNON ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-8757
Country	:	US
Telephone Number	:	480-522-0260
Fax Number	:

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

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	03/19/2023

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