Provider Demographics
NPI:1003844127
Name:CHILDERS, CHARLES GILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GILBERT
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7308
Mailing Address - Country:US
Mailing Address - Phone:253-475-5908
Mailing Address - Fax:253-475-5958
Practice Address - Street 1:2624 S 38TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7308
Practice Address - Country:US
Practice Address - Phone:253-475-5908
Practice Address - Fax:253-475-5958
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61438140207Q00000X
IL1250791502083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine