Provider Demographics
NPI:1336166370
Name:SONDEREGGER, CHARLES BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRIAN
Last Name:SONDEREGGER
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 1:412 W JOHN ST
Mailing Address - Street 2:STE B
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8829
Mailing Address - Country:US
Mailing Address - Phone:775-267-4872
Mailing Address - Fax:775-267-1980
Practice Address - Street 1:412 W JOHN ST
Practice Address - Street 2:STE B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8829
Practice Address - Country:US
Practice Address - Phone:775-267-4872
Practice Address - Fax:775-267-1980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013369Medicaid
VMD3390Medicare ID - Type Unspecified
NV002013369Medicaid