Provider Demographics
NPI:1598739195
Name:CICCONE, CHARLES ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:CICCONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2323 ARRIVISTE WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5902
Mailing Address - Country:US
Mailing Address - Phone:850-912-2294
Mailing Address - Fax:850-912-2445
Practice Address - Street 1:790 VETERANS WAY
Practice Address - Street 2:JOINT AMBULATORY CARE CLINIC
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507
Practice Address - Country:US
Practice Address - Phone:850-912-2294
Practice Address - Fax:850-912-2445
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78934207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine