Individual
DR. CHARLES A WETHERINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 BOWLES AVE STE 200, FENTON, MO 63026-2308
(636) 496-3900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
104062
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204694509
—
MO
Enumeration date
07/26/2005
Last updated
11/24/2020
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