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General NPI Number Information
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NPI Number | 1609125913
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Entity Type | Organization
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Legal Business Name | CHARLES C GREENE MD PHD PA
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 6484 FORT CAROLINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2042
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Country | US
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Telephone | 904-419-2054
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Fax | 904-419-2057
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Provider Business Mailing Address
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Address Line | PO BOX 864935
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City | ORLANDO
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State | FL
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Zip | 32886-4935
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Country | US
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Telephone | 904-419-2054
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Fax | 904-419-2057
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES C GREENE
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Credential |
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Telephone | 912-691-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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