Provider Demographics
NPI:1134123821
Name:CHARLES, KERRI M (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:360 S GARFIELD ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3186
Mailing Address - Country:US
Mailing Address - Phone:303-318-3520
Mailing Address - Fax:303-318-3510
Practice Address - Street 1:360 S GARFIELD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3186
Practice Address - Country:US
Practice Address - Phone:303-318-3520
Practice Address - Fax:303-318-3510
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA150529207Q00000X
WY11433A207Q00000X
FLME133313207Q00000X
IDM-13888207Q00000X
WAMD60771851207Q00000X
MTMED-PHYS-LIC-59836207Q00000X
AK124688207Q00000X
AZ54999207Q00000X
HIMD-19398207Q00000X
NMMD2017-0960207Q00000X
NV17595207Q00000X
ORMD183947207Q00000X
TXL6320207Q00000X
CO46230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011650723Medicaid
CO59284811Medicaid
COA100264Medicare PIN
TXI05139Medicare UPIN
CO59284811Medicaid
TX011650723Medicaid