Provider Demographics
NPI:1598862013
Name:CHARLES, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1578 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1638
Mailing Address - Country:US
Mailing Address - Phone:303-830-7200
Mailing Address - Fax:303-830-7523
Practice Address - Street 1:1578 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1638
Practice Address - Country:US
Practice Address - Phone:303-830-7200
Practice Address - Fax:303-830-7523
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20887208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01208875Medicaid
COE06411Medicare UPIN
CO01208875Medicaid