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General NPI Number Information
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NPI Number | 1750486460
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Entity Type | Individual
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Provider Name | CHARLES MCKINLEY ZOLLICOFFER MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 1871 SE TIFFANY AVE SUITE 200
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7585
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Country | US
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Telephone | 772-337-4000
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Fax | 772-335-4054
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Provider Business Mailing Address
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Address Line | 5827 CORPORATE WAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2000
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Country | US
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Telephone | 561-844-9443
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Fax | 561-472-9692
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 231571
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME 97653
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License Number State | FL
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