Provider Demographics
NPI:1316052012
Name:M. ARTHUR CHARLES, M.D.
Entity type:Organization
Organization Name:M. ARTHUR CHARLES, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-894-6850
Mailing Address - Street 1:2492 WALNUT AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6953
Mailing Address - Country:US
Mailing Address - Phone:714-734-7944
Mailing Address - Fax:714-734-7945
Practice Address - Street 1:2492 WALNUT AVE STE 130
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6953
Practice Address - Country:US
Practice Address - Phone:714-734-7944
Practice Address - Fax:714-734-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG224631744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15128Medicare ID - Type Unspecified
CAA89362Medicare UPIN