Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 27745 | OK |
N | 208600000X | Surgeon | 27745 | OK |
N | 208200000X | Surgeon | 303595 | NY |
N | 208600000X | Surgeon | 303595 | NY |
N | 208200000X | Surgeon | A99319 | CA |
N | 208600000X | Surgeon | A99319 | CA |
N | 208200000X | Surgeon | R2163 | TX |
N | 208600000X | Surgeon | R2163 | TX |
N | 2086S0102X | Surgical Critical Care | 27745 | OK |
N | 2086S0102X | Surgical Critical Care | 303595 | NY |
N | 2086S0102X | Surgical Critical Care | A99319 | CA |
Y | 2086S0102X | Surgical Critical Care | ME150816 | FL |
N | 2086S0102X | Surgical Critical Care | R2163 | TX |
N | 2086S0127X | Trauma Surgeon | 27745 | OK |
N | 2086S0127X | Trauma Surgeon | 303595 | NY |
N | 2086S0127X | Trauma Surgeon | A99319 | CA |
N | 2086S0127X | Trauma Surgeon | R2163 | TX |
NPI | 1053467894 |
---|---|
Provider Name | Dr. Charles Miles Maliska III |
First Address | Fort Pierce, FL 34950-4838 |
Second Address | Fort Pierce, FL 34950-4838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200330440A | (05) | OK |