Basic Information
| Provider Information | |||||||||
| NPI: | 1578982864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARAPATA | ||||||||
| FirstName: | NATHAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 LINCOLN ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FORT MORGAN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807013290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705424400 | ||||||||
| FaxNumber: | 9705424403 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 KINGS HWY | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711034228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188132528 | ||||||||
| FaxNumber: | 3188132565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13615C | WY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR.0059617 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.