Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME66239 | FL |
NPI | 1013936756 |
---|---|
Provider Name | Dr. Charles Barry Craythorne |
First Address | Lutz, FL 33548-4703 |
Second Address | Tampa, FL 33606-2767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 28/01/2010 |