Individual
MR. CHARLES EDWARD SELF
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1111 HOMER RD, MINDEN, LA 71055-3027
(318) 377-7500
(318) 377-2324
Mailing address
1611 GERMANTOWN RD, MINDEN, LA 71055-1301
(318) 469-6331
(318) 377-2324
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.A10425.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.A10425.RX
LA STATE PA LICENSE
LA
Enumeration date
09/21/2005
Last updated
07/09/2007
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