Provider Demographics
NPI:1790888147
Name:FRAGER, CHARLES RICHARD (M S, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:FRAGER
Suffix:
Gender:M
Credentials:M S, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5481
Mailing Address - Country:US
Mailing Address - Phone:239-434-0086
Mailing Address - Fax:239-434-9029
Practice Address - Street 1:1000 TAMIAMI TRL N
Practice Address - Street 2:SUITE 403
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5481
Practice Address - Country:US
Practice Address - Phone:239-434-0086
Practice Address - Fax:239-434-9029
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY160231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4391Medicare ID - Type UnspecifiedPROVIDER NUMBER