JERALD DIETRICH CHARLES

GREEN BAY, WI
NPI1396284154
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: WI  4028-023)
Additional Taxonomies363AS0400X Physician Assistant, Surgical
Enumeration Date2017-02-13
Last Update Date2021-12-14
Business Address
JERALD DIETRICH CHARLES PA-C
2845 GREENBRIER RD
GREEN BAY, WI 54311-6519
Phone number: 920-288-8320
Mailing Address
JERALD DIETRICH CHARLES PA-C
164 N. BROADWAY
GREEN BAY, WI 54303-2728
Phone number: 920-490-9046