Provider Demographics
NPI:1134121874
Name:JOST, CHARLES MT (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MT
Last Name:JOST
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 1:5416 E BASELINE RD STE 129
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4703
Mailing Address - Country:US
Mailing Address - Phone:480-945-4343
Mailing Address - Fax:480-945-4350
Practice Address - Street 1:7529 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2007
Practice Address - Country:US
Practice Address - Phone:480-945-4343
Practice Address - Fax:480-945-4350
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28064207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ492794Medicaid
AZ108830Medicare PIN
AZG09330Medicare UPIN
G09330Medicare UPIN
AZ492794Medicaid