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General NPI Number Information
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NPI Number | 1497729727
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Entity Type | Individual
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Provider Name | CHARLES EDWARD FLACK MD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 10301 HAGEN RANCH RD SUITE C130
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City | BOYNTON BEACH
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State | FL
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Zip | 33437
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Country | US
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Telephone | 561-736-7313
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Fax | 561-736-2309
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Provider Business Mailing Address
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Address Line | 1300 SAWGRASS CORPORATE PKWY STE 200
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City | SUNRISE
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State | FL
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Zip | 33323-2823
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Country | US
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Telephone | 800-243-3839
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Fax | 855-527-5510
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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 | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 0101273176
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | ME59937
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | TP103
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License Number State | KY
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