Healthcare Provider Details

I. General information

NPI: 1578662458
Provider Name (Legal Business Name): CHARLES MACIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 LINTON BLVD.
DELRAY BEACH FL
33445
US

IV. Provider business mailing address

P O 850001 DEPT 991
ORLANDO FL
32885-0991
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-9585
  • Fax:
Mailing address:
  • Phone: 800-248-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME70514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: