Provider Demographics
NPI:1801842141
Name:ASWELL, CHARLES JESSE III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JESSE
Last Name:ASWELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:503 JACK MILLER RD
Mailing Address - Street 2:# A
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5627
Mailing Address - Country:US
Mailing Address - Phone:337-363-7474
Mailing Address - Fax:337-363-1197
Practice Address - Street 1:503 JACK MILLER RD
Practice Address - Street 2:# A
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5627
Practice Address - Country:US
Practice Address - Phone:337-363-7474
Practice Address - Fax:337-363-1197
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA013360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50313OtherMEDICARE ID (UNSPECIFIED)
LA1188531Medicaid
LA1188531Medicaid