Provider Demographics
NPI:1063401347
Name:CHAFFEE, CHARLES TURNER (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:TURNER
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. KINCAID STREET
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:
Practice Address - Street 1:7530 204TH ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8912
Practice Address - Country:US
Practice Address - Phone:360-435-8810
Practice Address - Fax:360-435-3510
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013980207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1074509Medicaid
WA1578CHOtherREGENCE
WA007486001OtherGROUP HEALTH
A09077Medicare UPIN
WA007486001OtherGROUP HEALTH