Provider Demographics
NPI:1063402634
Name:PARADISE, CHARLES JOSEPH (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:PARADISE
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1333 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8219
Mailing Address - Country:US
Mailing Address - Phone:361-883-6211
Mailing Address - Fax:361-882-4891
Practice Address - Street 1:1333 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8219
Practice Address - Country:US
Practice Address - Phone:541-779-4711
Practice Address - Fax:541-779-0796
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX691160367500000X
OR202002199CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered