Provider Demographics
NPI:1538498126
Name:ALIX CHARLES, DPM, PA
Entity Type:Organization
Organization Name:ALIX CHARLES, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-766-4384
Mailing Address - Street 1:810 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4551
Mailing Address - Country:US
Mailing Address - Phone:954-766-4384
Mailing Address - Fax:954-703-4515
Practice Address - Street 1:810 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4551
Practice Address - Country:US
Practice Address - Phone:954-766-4384
Practice Address - Fax:954-703-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3379213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty