Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2009010647 | MO |
N | 208000000X | Pediatrician | ME126811 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | 2009010647 | MO |
Y | 2080P0204X | Pediatric Emergency Doctor | ME126811 | FL |
NPI | 1295912764 |
---|---|
Provider Name | Dr. Charles David Eldridge IV |
First Address | Saint Petersburg, FL 33701-4634 |
Second Address | Saint Petersburg, FL 33701-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 27/06/2016 |