Provider Demographics
NPI:1164676771
Name:DJRJ2
Entity Type:Organization
Organization Name:DJRJ2
Other - Org Name:COMPREHENSIVE WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHARL3S
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-365-3845
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-0805
Mailing Address - Country:US
Mailing Address - Phone:386-755-9190
Mailing Address - Fax:
Practice Address - Street 1:4225 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8841
Practice Address - Country:US
Practice Address - Phone:386-365-3845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82558207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274840100Medicaid