Provider Demographics
NPI:1417694381
Name:CHASE, CHARLES COMSTOCK (CAA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:COMSTOCK
Last Name:CHASE
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2008 SILVER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PALO
Mailing Address - State:IA
Mailing Address - Zip Code:52324-9648
Mailing Address - Country:US
Mailing Address - Phone:319-310-5820
Mailing Address - Fax:
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant