Provider Demographics
NPI:1053381053
Name:CHARLES, RICHARD (DPM)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:2961 ALTON CT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2896
Mailing Address - Country:US
Mailing Address - Phone:720-530-1122
Mailing Address - Fax:866-771-0081
Practice Address - Street 1:201 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4657
Practice Address - Country:US
Practice Address - Phone:303-355-1695
Practice Address - Fax:303-355-1834
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003458Medicaid
09107Medicare UPIN