Provider Demographics
NPI:1790956027
Name:BOAG, CHARLES BRIXNER III (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRIXNER
Last Name:BOAG
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:1950 W FRYE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6255
Mailing Address - Country:US
Mailing Address - Phone:480-895-9555
Mailing Address - Fax:480-895-9494
Practice Address - Street 1:4545 E CHANDLER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7645
Practice Address - Country:US
Practice Address - Phone:480-961-2330
Practice Address - Fax:480-961-2332
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
AZ4781207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ344868Medicaid