Provider Demographics
NPI:1144284373
Name:GARRETSON, CHARLES ARBIE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ARBIE
Last Name:GARRETSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ORO DAM BLVD E STE 12
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5934
Mailing Address - Country:US
Mailing Address - Phone:304-610-7267
Mailing Address - Fax:530-898-1204
Practice Address - Street 1:9792 LIVE OAK BLVD STE E
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2381
Practice Address - Country:US
Practice Address - Phone:304-610-7267
Practice Address - Fax:530-898-1204
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86610207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86610OtherSTATE LICENSE
CAGR0014101Medicaid
BG1524758OtherDEA
BG1524758OtherDEA
CAGR0014101Medicaid