Provider Demographics
NPI:1639351059
Name:POPE, CHARLES E (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:POPE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4085 UNIVERSITY BLVD S
Mailing Address - Street 2:STE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4357
Mailing Address - Country:US
Mailing Address - Phone:904-448-4174
Mailing Address - Fax:904-448-4181
Practice Address - Street 1:4085 UNIVERSITY BLVD S
Practice Address - Street 2:STE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4357
Practice Address - Country:US
Practice Address - Phone:904-448-4174
Practice Address - Fax:904-448-4181
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical