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General NPI Number Information
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NPI Number | 1205854312
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Entity Type | Individual
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Provider Name | CHARLES DUNN SCARBOROUGH MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 31 S 5TH ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2301
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Country | US
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Telephone | 904-259-2725
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Fax | 904-259-2907
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Provider Business Mailing Address
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Address Line | 31 S 5TH ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2301
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Country | US
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Telephone | 904-259-2725
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Fax | 904-259-2907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 18474
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License Number State | FL
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