Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 82-188 | NM |
NPI | 1962614826 |
---|---|
Provider Name | Charles F Eberle |
First Address | Los Ranchos, NM 87107 |
Second Address | Los Ranchos, NM 87107-5613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 31/12/2015 |