Provider Demographics
NPI:1407005549
Name:LEVESQUE, CHARLES L (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:LEVESQUE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5155 E EAGLE DR UNIT 20730
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-3031
Mailing Address - Country:US
Mailing Address - Phone:480-708-9430
Mailing Address - Fax:480-378-2273
Practice Address - Street 1:5155 E EAGLE DR UNIT 20730
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85277-3031
Practice Address - Country:US
Practice Address - Phone:480-706-9430
Practice Address - Fax:480-378-2273
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2024-04-24
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Provider Licenses
StateLicense IDTaxonomies
AZ1621363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical