Healthcare Provider Details

I. General information

NPI: 1740269448
Provider Name (Legal Business Name): CHARLES BRADLEY ARBOGAST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E REDSTONE AVE
CRESTVIEW FL
32539-5373
US

IV. Provider business mailing address

PO BOX 11037
PENSACOLA FL
32524-1037
US

V. Phone/Fax

Practice location:
  • Phone: 850-444-4700
  • Fax: 850-862-0482
Mailing address:
  • Phone: 850-444-4700
  • Fax: 850-862-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS13671
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS13671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: