Provider Demographics
NPI:1710107131
Name:CARR, CHARLES TOBY
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:TOBY
Last Name:CARR
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:KAY
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19064 W 61ST PL
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1031
Mailing Address - Country:US
Mailing Address - Phone:303-279-7977
Mailing Address - Fax:303-279-1012
Practice Address - Street 1:19064 W 61ST PL
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1031
Practice Address - Country:US
Practice Address - Phone:303-279-7077
Practice Address - Fax:303-279-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56308779Medicaid