Provider Demographics
NPI:1275657207
Name:ST HILL, CHARLES RANDOLPH (MD, MSC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RANDOLPH
Last Name:ST HILL
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1973
Mailing Address - Country:US
Mailing Address - Phone:702-780-7118
Mailing Address - Fax:702-895-4014
Practice Address - Street 1:1707 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2351
Practice Address - Country:US
Practice Address - Phone:702-671-5010
Practice Address - Fax:702-384-6493
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43337208600000X
NV143162086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery