Individual
DR. CHARLES ADAMS BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
FORT DEFIANCE INDIAN HOSPITAL, CORNER ROUTE N7 AND N12, FORT DEFIANCE, AZ 86504
(928) 729-8600
Mailing address
3437 CALLE SUENOS SE, RIO RANCHO, NM 87124-6712
(505) 896-4093
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
22395
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000R4843
NM MED
NM
01
—
638679
AHCCCS
AZ
Enumeration date
12/13/2006
Last updated
07/08/2007
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