Provider Demographics
NPI:1881667145
Name:HUNDLEY, CHARLES P (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:HUNDLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 NW EDENBOWER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6214
Mailing Address - Country:US
Mailing Address - Phone:541-677-7200
Mailing Address - Fax:541-229-3363
Practice Address - Street 1:2570 NW EDENBOWER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6220
Practice Address - Country:US
Practice Address - Phone:541-677-7200
Practice Address - Fax:541-229-3363
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080122364OtherIND RAILROAD
OR000188014OtherIND BLUE CROSS
OR063776Medicaid
OR100941Medicare ID - Type UnspecifiedIND MEDICARE
OR080122364OtherIND RAILROAD