Healthcare Provider Details

I. General information

NPI: 1265685770
Provider Name (Legal Business Name): CHARLES DOERR CP,BOCP,RTP,,BOCPED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax: 813-903-4837
Mailing address:
  • Phone: 813-972-2000
  • Fax: 813-903-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number224P00000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: