Provider Demographics
NPI:1528020807
Name:HEARD, CHARLES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:HEARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:345 W MICHIGAN ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4465
Mailing Address - Country:US
Mailing Address - Phone:407-843-9083
Mailing Address - Fax:407-420-2900
Practice Address - Street 1:345 W MICHIGAN ST
Practice Address - Street 2:SUITE 114
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4465
Practice Address - Country:US
Practice Address - Phone:407-843-9083
Practice Address - Fax:407-420-2900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME39318207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1591807OtherCIGNA
FL4008416OtherAETNA
FLD55087Medicare UPIN
FL1591807OtherCIGNA