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General NPI Number Information
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NPI Number | 1962813790
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Entity Type | Organization
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Legal Business Name | CHARLES RICHARD UNDERWOOD MD PLLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 400 8TH ST N
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City | NAPLES
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State | FL
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Zip | 34102-5519
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Country | US
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Telephone | 239-595-6687
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Fax |
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Provider Business Mailing Address
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Address Line | 400 8TH ST N
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City | NAPLES
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State | FL
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Zip | 34102-5519
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Country | US
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Telephone | 239-595-6687
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JANE E STAFFORD
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Credential |
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Telephone | 239-514-7734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME38081
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License Number State | FL
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