Provider Demographics
NPI:1396865838
Name:STRICKER, CHARLES X (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:X
Last Name:STRICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4303 E LORI LEI CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-3501
Mailing Address - Country:US
Mailing Address - Phone:417-838-7946
Mailing Address - Fax:760-346-2297
Practice Address - Street 1:4303 E LORI LEI CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-3501
Practice Address - Country:US
Practice Address - Phone:417-838-7946
Practice Address - Fax:760-346-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO359992085R0202X, 2085R0202X
WA000461472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13475Medicare UPIN