Provider Demographics
NPI:1447291067
Name:EDWARDS, CHARLES CHRISTOPHER (DPM)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 DIPLOMACY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-1500
Mailing Address - Fax:907-729-2082
Practice Address - Street 1:4315 DIPLOMACY DRIVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-1500
Practice Address - Fax:907-729-2082
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5109207R00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPD26281Medicaid
AKPD26281Medicaid
AKU95182Medicare UPIN