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Contact Information

CHARLES C CANVER, MD, MBA
3000 32ND AVE S
FARGO, ND58103-6132
 Phone: 701-364-8000
 Fax: 573-302-2268
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Thoracic Surgery (Cardiothoracic Vascular Surgery)

208G00000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for CHARLES C CANVER · (Male)

NPI # 1477855450
Status Active
Credentials MD, MBA
Entity Individual
Enumeration date 11/24/2010
Last updated 01/31/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01060317A
  • ND License # 19268
  • NH License # 8603
Hospital affiliation(s)
  • LAKE REGIONAL HEALTH SYSTEM - (Acute Care)
    54 HOSPITAL DRIVE
    OSAGE BEACH, MO 65065
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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