Individual
CHARLES B VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1791 HIGHWAY 64 E, ANAMOSA, IA 52205-2112
(319) 462-3571
(319) 462-6043
Mailing address
1791 HIGHWAY 64 E, ANAMOSA, IA 52205-2112
(319) 462-3571
(319) 462-6043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24257
IA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
24257
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080116811
RR MEDICARE
IA
05
—
1225016009
—
IA
05
—
3019570
—
IA
Enumeration date
01/03/2006
Last updated
05/16/2012
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