Individual
DR. CHARLES DAVID SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 S SHOOP AVE, WAUSEON, OH 43567-1702
(419) 335-2015
Mailing address
3501 S CRISSEY RD, MONCLOVA, OH 43542-9766
(419) 350-5652
(419) 861-8335
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35057726
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522471
ANTHEM BCBS
OH
05
—
0725666
—
OH
05
—
5214037
—
MI
01
—
810547599071
CARESOURCE
OH
Enumeration date
03/05/2006
Last updated
11/16/2007
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