MEDICARE: CHARLES EDWARD FAULK DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO4791	FL

General Provider Information

NPI Number	:	1679420012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES EDWARD FAULK DPM

Provider Business Mailing Address
First Line	:	800 BELLE TERRE PKWY STE 112
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2315
Country	:	US
Telephone Number	:	386-777-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BELLE TERRE PKWY STE 112
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2315
Country	:	US
Telephone Number	:	386-777-7311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	06/04/2026

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