Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME83408 | FL |
NPI | 1043284425 |
---|---|
Provider Name | Dr. Leroy Charles |
First Address | Loxahatchee, FL 33470-4932 |
Second Address | Loxahatchee, FL 33470-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 25/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A67802 | (02) | FL |