Provider Demographics
NPI:1265851901
Name:CERONIO, CHARL FREDERICK DU TOIT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARL
Middle Name:FREDERICK DU TOIT
Last Name:CERONIO
Suffix:
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 1:1102 N PINE RD
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-4804
Mailing Address - Country:US
Mailing Address - Phone:318-446-4534
Mailing Address - Fax:
Practice Address - Street 1:1102 N PINE RD
Practice Address - Street 2:
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465-4804
Practice Address - Country:US
Practice Address - Phone:318-446-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine