Individual
DR. JOHN CHARBONNEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2471
(970) 350-2418
Mailing address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2471
(970) 350-2418
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
DR.0030255
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01302553
—
CO
01
—
P00944678
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
02/06/2006
Last updated
08/19/2016
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