Individual
DR. CHARLES MICHAEL HERNDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3760 PIPER ST, SUITE 1108, ANCHORAGE, AK 99508-4683
(907) 212-6970
(907) 212-6971
Mailing address
PO BOX 4105, PORTLAND, OR 97208-4105
(866) 907-1068
(425) 917-9141
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
2370
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007300
—
AK
Enumeration date
07/26/2006
Last updated
09/30/2020
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