Provider Demographics
NPI:1518947845
Name:FUERSTE, CHARLES ROMMEL (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROMMEL
Last Name:FUERSTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:C
Other - Middle Name:ROMMEL
Other - Last Name:FUERSTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2930 SPRING OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7506
Mailing Address - Country:US
Mailing Address - Phone:563-556-1684
Mailing Address - Fax:
Practice Address - Street 1:2140 JFK RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3883
Practice Address - Country:US
Practice Address - Phone:563-582-0769
Practice Address - Fax:563-582-5772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24338207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31479800Medicaid
IA0072215Medicaid
IA0072215Medicaid
WI31479800Medicaid