Provider Demographics
NPI:1295863322
Name:THOMPSON, CHARLES R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:6510 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4778
Practice Address - Country:US
Practice Address - Phone:850-983-8500
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2022-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 53590207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC74213Medicare UPIN
FL07037AMedicare PIN