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NPI Code Detail

MEDICARE: CHARLES E GAGNON D.O.

MEDICARE: CHARLES E GAGNON D.O.
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
12083X0100XOccupational Medicine Physician3077AZ

General Provider Information

NPI Number : 1780709980
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES E GAGNON D.O.
Provider Business Mailing Address
First Line : 720 COOL SPRINGS BLVD
Second Line : SUITE 300
City : FRANKLIN
State : TN
Zip : 37067-2626
Country : US
Telephone Number : 615-778-4066
Fax Number : 615-778-9114
Provider Business Practice Location Address
First Line : 901 E JEFFERSON ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85034-2219
Country : US
Telephone Number : 615-778-4066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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