Provider Demographics
NPI:1700873221
Name:SHURLOW, CHARLES ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:SHURLOW
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2510 5TH ST
Mailing Address - Street 2:BLDG 840, AREA B
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-7951
Mailing Address - Country:US
Mailing Address - Phone:937-938-2736
Mailing Address - Fax:937-656-4006
Practice Address - Street 1:2510 5TH ST
Practice Address - Street 2:BLDG 840, AREA B
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-7951
Practice Address - Country:US
Practice Address - Phone:937-938-2736
Practice Address - Fax:937-656-4006
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010571207P00000X, 207Q00000X
OH34.009947207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine