Provider Demographics
NPI:1801094495
Name:GARCIA, CHARLES BURTON (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BURTON
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 EDMONTON DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6092
Mailing Address - Country:US
Mailing Address - Phone:775-440-0336
Mailing Address - Fax:702-383-8235
Practice Address - Street 1:235 W 6TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4548
Practice Address - Country:US
Practice Address - Phone:757-703-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1540207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO1540OtherNEVADA OSTEOPATHIC MEDICAL LICENSE
NVDO1540OtherNEVADA OSTEOPATHIC MEDICAL LICENSE
ASO2532199401OtherRESIDENCY DEA
NVFG1963417OtherDEA