Provider Demographics
NPI:1407851942
Name:ZACHEM, CHARLES R (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:ZACHEM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HILYARD ST
Mailing Address - Street 2:STE 470
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8107
Mailing Address - Country:US
Mailing Address - Phone:541-485-6478
Mailing Address - Fax:541-485-0452
Practice Address - Street 1:1200 HILYARD ST
Practice Address - Street 2:STE 470
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8107
Practice Address - Country:US
Practice Address - Phone:541-485-6478
Practice Address - Fax:541-485-0452
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO20422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150027Medicare ID - Type Unspecified
ORG44610Medicare UPIN
OR00WCJFCEMedicare ID - Type Unspecified