Provider Demographics
NPI:1851351530
Name:RICH, CHARLES C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:STE 950
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9555
Mailing Address - Fax:801-507-9550
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:STE 950
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9555
Practice Address - Fax:801-507-9550
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3717651205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00070997Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UTH01380Medicare UPIN
UT005728301Medicare ID - Type UnspecifiedSALT LAKE MEDICARE ID
UT005735101Medicare ID - Type UnspecifiedPARK CITY MEDICARE ID