Provider Demographics
NPI:1770586778
Name:SEXTON, CHARLES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:SEXTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15825 LAGUNA CANYON RD
Mailing Address - Street 2:STE 203
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2127
Mailing Address - Country:US
Mailing Address - Phone:949-679-6900
Mailing Address - Fax:949-679-6096
Practice Address - Street 1:15825 LAGUNA CANYON RD
Practice Address - Street 2:STE 203
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2127
Practice Address - Country:US
Practice Address - Phone:949-679-6900
Practice Address - Fax:949-679-6096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG73919207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73919Medicare ID - Type Unspecified