MEDICARE: CHARLES ALEXANDER PRENTICE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME038475	FL

General Provider Information

NPI Number	:	1134124951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ALEXANDER PRENTICE MD

Provider Business Mailing Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	352-726-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	352-726-9006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/09/2012

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Directions to “ CHARLES ALEXANDER PRENTICE MD” Practice Location

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