Provider Demographics
NPI:1487640702
Name:STROBLE, CHARLES P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:STROBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13024
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32591-3024
Mailing Address - Country:US
Mailing Address - Phone:850-435-8300
Mailing Address - Fax:850-435-8352
Practice Address - Street 1:9800 US HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-4964
Practice Address - Country:US
Practice Address - Phone:850-278-3555
Practice Address - Fax:850-278-3562
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME866152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272337900Medicaid
FLK7166Medicare ID - Type Unspecified
FL272337900Medicaid