Provider Demographics
NPI:1093775231
Name:FLETCHER, CHARLES T JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:FLETCHER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3563
Mailing Address - Country:US
Mailing Address - Phone:334-613-9000
Mailing Address - Fax:334-532-0056
Practice Address - Street 1:454 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3563
Practice Address - Country:US
Practice Address - Phone:334-613-9000
Practice Address - Fax:334-532-0056
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011026207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939358Medicaid
AL009939359Medicaid
200026239OtherRAILROAD MEDICARE
AL510-07497OtherBCBS
AL000037187Medicaid
AL510-01332OtherBCBS
AL510-37187OtherBCBS
AL0910137OtherUNITED HEALTHCARE
AL510-37187OtherBCBS
AL510-01332OtherBCBS