Provider Demographics
NPI:1750491049
Name:YEAGLE, CHARLES FRANCIS III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANCIS
Last Name:YEAGLE
Suffix:III
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 1:400 BENEDICTA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2099
Mailing Address - Country:US
Mailing Address - Phone:719-846-1700
Mailing Address - Fax:719-846-1704
Practice Address - Street 1:400 BENEDICTA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2099
Practice Address - Country:US
Practice Address - Phone:719-846-1700
Practice Address - Fax:719-846-1704
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66104246Medicaid
530898Medicare ID - Type Unspecified
D52618Medicare UPIN