Organization
CHARLES K. DAHLGREN, M.D., CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES KENNETH DAHLGREN MD (OWNER)
(775) 738-2555
Entity
Organization
Contact information
Practice address
1995 ERRECART BLVD STE 109, ELKO, NV 89801-8336
(775) 738-2555
Mailing address
1995 ERRECART BLVD STE 109, ELKO, NV 89801-8336
(775) 738-2555
Taxonomy
Speciality
Code
Description
License number
State
207YX0602X
Otolaryngic Allergy Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507648
—
NV
01
—
101836
MEDICARE
—
01
—
11563
NEVADA STATE LICENSE
NV
01
—
A20663
CALIFORNIA STATE LICENSE
CA
01
—
A22258
UPIN
—
01
—
P00273393
RR MEDICARE
—
Enumeration date
03/03/2008
Last updated
11/05/2009
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