Provider Demographics
NPI:1144254624
Name:GLOVER, CHARLES F (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:GLOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 2497
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92088-2497
Mailing Address - Country:US
Mailing Address - Phone:790-728-3202
Mailing Address - Fax:760-728-1901
Practice Address - Street 1:HEMET RADIOLOGY MEDICAL GROUP, INC.
Practice Address - Street 2:235 LAURSEN STREET
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-765-5417
Practice Address - Fax:951-765-5418
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG128612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G128610Medicaid
E39613Medicare UPIN
CA00G128610Medicaid