Individual
MR. CHARLES REGINALD ELAM IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 MEDICAL PKWY, DENISON, IA 51442-2607
(712) 265-2683
(712) 265-2682
Mailing address
100 MEDICAL PKWY, DENISON, IA 51442-2607
(712) 265-2683
(712) 265-2682
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D138067
IA
Other
Enumeration date
12/06/2010
Last updated
11/02/2016
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