Provider Demographics
NPI:1417182502
Name:FAWSETT, CHARLES ROBINSON II
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBINSON
Last Name:FAWSETT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W. EIGHTH ST. BOX C506
Mailing Address - Street 2:CLINICAL CENTER, 1ST FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-244-3837
Mailing Address - Fax:904-244-4508
Practice Address - Street 1:655 W. EIGHTH ST.
Practice Address - Street 2:CLINICAL CENTER, 1ST FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-3837
Practice Address - Fax:904-244-4508
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine