Individual
CHARLES BELLANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1300 N 12TH ST STE 301, PHOENIX, AZ 85006-2813
(602) 239-6968
(602) 239-4144
Mailing address
6032 W WILLOW AVE, GLENDALE, AZ 85304-1101
(623) 979-4699
(623) 878-4629
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1065
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103391-06
—
CA
Enumeration date
07/11/2006
Last updated
02/15/2008
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