Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO3379 | FL |
NPI | 1023114600 |
---|---|
Provider Name | Dr. Alix Charles |
First Address | Fort Lauderdale, FL 33312-7329 |
Second Address | Plantation, FL 33317-4551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 25/11/2019 |