Provider Demographics
NPI:1609978238
Name:JOSEPH, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W ANTELOPE DR
Mailing Address - Street 2:# 290 ROCKY MOUNTAIN OB GYN
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-776-0880
Mailing Address - Fax:801-773-7399
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:# 290 ROCKY MOUNTAIN OB GYN
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-776-0880
Practice Address - Fax:801-773-7399
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1539801205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000004521Medicare ID - Type Unspecified
D20408Medicare UPIN