Individual
DR. CHARLES KENNETH REQUARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5515 E 5TH ST, C/O ARIZONA COMMUNITY PHYSICIANS, TUCSON, AZ 85711-2415
(520) 298-1138
(520) 547-5959
Mailing address
1961 N CORTE EL RANCHO MERLITA, TUCSON, AZ 85715-4493
(520) 780-1281
(520) 547-5959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
13725
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8552002
—
AZ
Enumeration date
07/27/2006
Last updated
12/30/2013
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