Individual
MR. CHARLES W ANDEREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1701 N 13TH ST STE A, SHELTON, WA 98584-2077
(360) 426-2653
Mailing address
PO BOX 1668, SHELTON, WA 98584-5001
(360) 427-9549
(360) 427-3661
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
MA052594
PA
363AS0400X
Surgical Physician Assistant
Primary
PA10003420
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8521973
—
WA
Enumeration date
06/28/2006
Last updated
11/16/2020
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