Provider Demographics
NPI:1619949294
Name:CITRUS UROLOGY ASSOCIATES P A
Entity Type:Organization
Organization Name:CITRUS UROLOGY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-742-2201
Mailing Address - Street 1:1210 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5229
Mailing Address - Country:US
Mailing Address - Phone:352-742-2201
Mailing Address - Fax:352-742-2226
Practice Address - Street 1:1210 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5229
Practice Address - Country:US
Practice Address - Phone:352-742-2201
Practice Address - Fax:352-742-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D1018775208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA4769OtherRAILROAD MEDICARE
FL0604763000Medicaid
FL98224OtherBLUE CROSS BLUE SHEILD
FLDA4769OtherRAILROAD MEDICARE