Provider Demographics
NPI:1457358608
Name:HECHT, CHARLES IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:IRWIN
Last Name:HECHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:IRWIN
Other - Last Name:HECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 39179
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9179
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:19424 N R H JOHNSON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-1409
Practice Address - Country:US
Practice Address - Phone:602-568-7114
Practice Address - Fax:623-388-6237
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11951208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ211475Medicaid
C99622Medicare UPIN