Provider Demographics
NPI:1790930212
Name:CHARLES V. PLEDGER M.D., P.C.
Entity Type:Organization
Organization Name:CHARLES V. PLEDGER M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-373-4300
Mailing Address - Street 1:3650 N UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6658
Mailing Address - Country:US
Mailing Address - Phone:801-373-4300
Mailing Address - Fax:801-418-0217
Practice Address - Street 1:3650 N UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6658
Practice Address - Country:US
Practice Address - Phone:801-373-4300
Practice Address - Fax:801-418-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty