Provider Demographics
NPI:1548373814
Name:FLAKE, CHARLES R (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:FLAKE
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 1:3003 ISLAND CREST WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER IS
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-232-5400
Mailing Address - Fax:206-232-9179
Practice Address - Street 1:3003 ISLAND CREST WAY
Practice Address - Street 2:
Practice Address - City:MERCER IS
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:206-232-5400
Practice Address - Fax:206-232-9179
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020623207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1227305Medicaid
WAF415OtherREGENCE BLUE SHIELD
WAF415OtherREGENCE BLUE SHIELD