Provider Demographics
NPI:1518278142
Name:ANTHONY, CHARLES II (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:ANTHONY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 DR MARTIN LUTHER KING JR ST N STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4272
Mailing Address - Country:US
Mailing Address - Phone:727-820-3223
Mailing Address - Fax:727-820-3224
Practice Address - Street 1:1901 DR MARTIN LUTHER KING JR ST N STE B
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4272
Practice Address - Country:US
Practice Address - Phone:727-820-3223
Practice Address - Fax:727-820-3224
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112414207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR72126OtherTRAINING PERMIT