Individual
CHARLES W MAILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 NORTH THIRD, SANDPOINT, ID 83864-1507
(208) 263-1441
(208) 265-1278
Mailing address
PO BOX 1448, SANDPOINT, ID 83864-0877
(208) 263-1441
(208) 265-1278
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
25618
MN
2085R0202X
Diagnostic Radiology Physician
25618
MN
2085R0202X
Diagnostic Radiology Physician
Primary
M9573
ID
2085U0001X
Diagnostic Ultrasound Physician
25618
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
787573800
—
MN
05
—
807532600
—
ID
Enumeration date
08/02/2005
Last updated
02/05/2010
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