Healthcare Provider Details

I. General information

NPI: 1275638694
Provider Name (Legal Business Name): CHARLTON LANCE ADLER D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR 235
NORTH MIAMI BEACH FL
33179-4707
US

IV. Provider business mailing address

1380 NE MIAMI GARDENS DR 235
NORTH MIAMI BEACH FL
33179-4707
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-3999
  • Fax: 305-936-8231
Mailing address:
  • Phone: 305-935-3999
  • Fax: 305-936-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO1744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: