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General NPI Number Information
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NPI Number | 1013293109
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Entity Type | Organization
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Legal Business Name | CHARLES A PRENTICE MD PA
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 214 S PINE AVE
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City | INVERNESS
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State | FL
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Zip | 34452-4838
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Country | US
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Telephone | 352-726-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 214 S PINE AVE
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City | INVERNESS
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State | FL
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Zip | 34452-4838
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Country | US
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Telephone | 352-726-9006
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CHARLES ALEXANDER PRENTICE
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Credential | MD
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Telephone | 352-726-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME38475
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License Number State | FL
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