Healthcare Provider Details

I. General information

NPI: 1003862244
Provider Name (Legal Business Name): CHARLES CURRY EAVES JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HOSPITAL DR
MARIANNA FL
32446-1917
US

IV. Provider business mailing address

3663 PRESERVE BLVD
PANAMA CITY BEACH FL
32408-7141
US

V. Phone/Fax

Practice location:
  • Phone: 850-716-2561
  • Fax:
Mailing address:
  • Phone: 850-896-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS14631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: