Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME85194 | FL |
NPI | 1053347468 |
---|---|
Provider Name | Dr. Charles T Klodell JR. |
First Address | Gainesville, FL 32605-4381 |
Second Address | Gainesville, FL 32605-4381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265166100 | (05) | FL |