Provider Demographics
NPI:1023199825
Name:CANFIELD, CHARLES OLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:OLIN
Last Name:CANFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 709391
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-9391
Mailing Address - Country:US
Mailing Address - Phone:801-877-0705
Mailing Address - Fax:801-335-5957
Practice Address - Street 1:10437 S JORDAN GTWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3915
Practice Address - Country:US
Practice Address - Phone:801-877-0705
Practice Address - Fax:801-335-5957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT182809-1205207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine