Provider Demographics
NPI:1194854539
Name:HOUSE, CHARLES MARSHALL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARSHALL
Last Name:HOUSE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4607 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7866
Mailing Address - Country:US
Mailing Address - Phone:904-269-4559
Mailing Address - Fax:904-269-4597
Practice Address - Street 1:4607 HIGHWAY 17 SOUTH
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-7866
Practice Address - Country:US
Practice Address - Phone:904-269-4559
Practice Address - Fax:904-269-4597
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2014-05-09
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Provider Licenses
StateLicense IDTaxonomies
FLME14495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine