Provider Demographics
NPI:1780672147
Name:HAMBY, CHARLES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:HAMBY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1839 BROKEN BEND DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8205
Mailing Address - Country:US
Mailing Address - Phone:630-607-1257
Mailing Address - Fax:312-261-9937
Practice Address - Street 1:1839 BROKEN BEND DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-8205
Practice Address - Country:US
Practice Address - Phone:630-607-1257
Practice Address - Fax:312-261-9937
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2016-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36114153207R00000X
TXQ7696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI42304Medicare UPIN