Individual
CHARLES HENLEY MEDBERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 WOODLAND HILLS BLVD, FORT SCOTT, KS 66701-8797
(620) 223-2200
Mailing address
5800 FOXRIDGE DR, STE 240, MISSION, KS 66202-2338
(913) 261-3153
(913) 262-3295
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
04-28353
KS
2085R0202X
Diagnostic Radiology Physician
107212
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100171060C
—
KS
05
—
207821547
—
MO
01
—
P00173775
RR MEDICARE
KS
Enumeration date
06/16/2005
Last updated
08/22/2013
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