Provider Demographics
NPI:1407005549
Name:LEVESQUE, CHARLES L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:LEVESQUE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1776 N SCOTTSDALE RD UNIT 368
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-3616
Mailing Address - Country:US
Mailing Address - Phone:480-201-5264
Mailing Address - Fax:480-393-1970
Practice Address - Street 1:1776 N SCOTTSDALE RD UNIT 368
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85252-3616
Practice Address - Country:US
Practice Address - Phone:480-201-5264
Practice Address - Fax:480-393-1970
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2018-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1621363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical