Individual
PATRICK CHARBONNEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6051 HIGHWAY 49, HATTIESBURG, MS 39401-7200
(601) 288-7000
Mailing address
8 PARK PL, #302-M, HATTIESBURG, MS 39402-1567
(601) 264-9982
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
17545
MS
207P00000X
Emergency Medicine Physician
Primary
M8587
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03923081
—
MS
01
—
1720020373
BCBXTX
TX
05
—
193109901
—
TX
01
—
8BB100
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
06/11/2006
Last updated
11/11/2010
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