Provider Demographics
NPI:1710136577
Name:CHARLES D. SCARBOROUGH M.D.
Entity Type:Organization
Organization Name:CHARLES D. SCARBOROUGH M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-259-2725
Mailing Address - Street 1:31 SOUTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2301
Mailing Address - Country:US
Mailing Address - Phone:904-259-2725
Mailing Address - Fax:904-259-2907
Practice Address - Street 1:31 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2301
Practice Address - Country:US
Practice Address - Phone:904-259-2725
Practice Address - Fax:904-259-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME018474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty