Provider Demographics
NPI:1518167428
Name:DUSHACK, CHARLES ROBERT III (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:DUSHACK
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 GLADIOLUS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6699
Mailing Address - Country:US
Mailing Address - Phone:239-433-0064
Mailing Address - Fax:239-433-0224
Practice Address - Street 1:9400 GLADIOLUS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6699
Practice Address - Country:US
Practice Address - Phone:239-433-0064
Practice Address - Fax:239-433-0224
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-3600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery