Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME99856 | FL |
N | 207PP0204X | Pediatric Emergency Physician | IL | |
N | 207PP0204X | Pediatric Emergency Physician | 31212 | WI |
NPI | 1558358143 |
---|---|
Provider Name | Dr. Charles J Havel JR. |
First Address | Sanibel, FL 33957-6409 |
Second Address | Lehigh Acres, FL 33936-4835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 01/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89673 | (02) | WI |