Provider Demographics
NPI:1972823532
Name:CHESNUT, CHARLES H III (DO, MS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:CHESNUT
Suffix:III
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:702-853-3300
Mailing Address - Fax:702-640-0604
Practice Address - Street 1:5320 S RAINBOW BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1896
Practice Address - Country:US
Practice Address - Phone:702-853-3300
Practice Address - Fax:702-640-0604
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1972823532Medicaid