Provider Demographics
NPI:1396826707
Name:GARNETTE, CHARLES S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:GARNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 690998
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0998
Mailing Address - Country:US
Mailing Address - Phone:407-363-7760
Mailing Address - Fax:407-363-7473
Practice Address - Street 1:7412 DOCS GROVE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-363-7760
Practice Address - Fax:407-363-7473
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME900942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH14686Medicare UPIN
FL46022ZMedicare PIN