1962614826 NPI number — CHARLES F EBERLE M.D.

Table of content: CHARLES F EBERLE M.D. (NPI 1962614826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962614826 NPI number — CHARLES F EBERLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBERLE
Provider First Name:
CHARLES
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962614826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 MEOQUI CT. NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS RANCHOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-688-5032
Provider Business Mailing Address Fax Number:
505-344-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6501 MEOQUI CT NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS RANCHOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-688-5032
Provider Business Practice Location Address Fax Number:
505-344-1698
Provider Enumeration Date:
05/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  82-188 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)