Provider Demographics
NPI:1447616040
Name:GESKE, CHARLES JOSHUA (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSHUA
Last Name:GESKE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-364-4200
Mailing Address - Fax:314-364-6321
Practice Address - Street 1:7001 ROGERS AVE STE 401A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4034
Practice Address - Country:US
Practice Address - Phone:479-314-4650
Practice Address - Fax:479-452-9459
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2024-04-18
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Provider Licenses
StateLicense IDTaxonomies
ARPA-650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant