Basic Information
| Provider Information | |||||||||
| NPI: | 1790882041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | APONTE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2037 JIMMY STEWART DRIVE | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4970 HIGHWAY 90 | ||||||||
| Address2: | MARIANNA VA CLINIC | ||||||||
| City: | MARIANNA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507185620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10253 | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301079042 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 432419 | 01 | AZ | AHCCCS | OTHER |