Provider Demographics
NPI:1861487589
Name:CHARLES, WILBERT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:WILBERT
Middle Name:EUGENE
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 ARABIAN CIR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4161
Mailing Address - Country:US
Mailing Address - Phone:707-761-9144
Mailing Address - Fax:
Practice Address - Street 1:2415 HIGH SCHOOL AVE STE 700
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1879
Practice Address - Country:US
Practice Address - Phone:415-848-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061292L207Q00000X
CAC54288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine