Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 02002597A | IN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | OS14031 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 34-00-7236-Z | OH |
NPI | 1720086366 |
---|---|
Provider Name | Dr. Charles J Zeller IV |
First Address | Fort Lauderdale, FL 33309-3750 |
Second Address | Fort Lauderdale, FL 33316-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 08/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017597600 | (05) | FL |
H82224 | (02) | OH |