Provider Demographics
NPI:1407048671
Name:OSTRANDER, CHARLES LEE (MED)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEE
Last Name:OSTRANDER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-0038
Mailing Address - Country:US
Mailing Address - Phone:520-366-6204
Mailing Address - Fax:520-366-0313
Practice Address - Street 1:10385 E. HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-0038
Practice Address - Country:US
Practice Address - Phone:520-366-6204
Practice Address - Fax:520-366-0313
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3916401251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)