Provider Demographics
NPI:1437116555
Name:TAWA, CHARLES E (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:TAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4943 STATE HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9100
Mailing Address - Country:US
Mailing Address - Phone:303-501-2600
Mailing Address - Fax:303-833-7017
Practice Address - Street 1:4943 STATE HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9100
Practice Address - Country:US
Practice Address - Phone:303-501-2600
Practice Address - Fax:303-833-7017
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01287903Medicaid
COC805562OtherMEDICARE
E97944Medicare UPIN
CO01287903Medicaid