Healthcare Provider Details

I. General information

NPI: 1982665055
Provider Name (Legal Business Name): CHARLES R READDY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14055 RIVEREDGE DR STE 250
TAMPA FL
33637-2141
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3065
US

V. Phone/Fax

Practice location:
  • Phone: 813-396-6238
  • Fax: 813-929-5465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS7332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: