Provider Demographics
NPI:1770529786
Name:BRONDOS, CHARLES E (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:BRONDOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 S COWLEY ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1375
Mailing Address - Country:US
Mailing Address - Phone:509-624-9154
Mailing Address - Fax:509-838-0102
Practice Address - Street 1:715 S COWLEY ST
Practice Address - Street 2:SUITE 224
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1375
Practice Address - Country:US
Practice Address - Phone:509-624-9154
Practice Address - Fax:509-838-0102
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA136522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1045905Medicaid
WA31507OtherLABOR AND INDUSTRIES
MT35-9723Medicaid
IDKA634OtherBLUE CROSS OF IDAHO
E01073OtherASURIS
WAA07109Medicare UPIN