Provider Demographics
NPI:1124095716
Name:CHAPMAN, CHARLES L (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-815-6631
Mailing Address - Fax:573-815-6634
Practice Address - Street 1:900 W NIFONG BLVD
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4467
Practice Address - Country:US
Practice Address - Phone:573-815-6631
Practice Address - Fax:573-815-6634
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-02-07
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Provider Licenses
StateLicense IDTaxonomies
MO28429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200582112Medicaid
A10975Medicare UPIN
A10975Medicare UPIN