Provider Demographics
NPI:1396835054
Name:WENNOGLE, CHARLES FRANCIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANCIS
Last Name:WENNOGLE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6189 MASSIVE PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9485
Mailing Address - Country:US
Mailing Address - Phone:720-219-7536
Mailing Address - Fax:
Practice Address - Street 1:9582 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6992
Practice Address - Country:US
Practice Address - Phone:719-593-1799
Practice Address - Fax:719-265-3794
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO400372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I02511Medicare UPIN