Provider Demographics
NPI:1942277470
Name:DAY, CHARLES MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:DAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450077 STATE ROAD 200 STE 12
Practice Address - Street 2:UFJP CALLAHAN FAMILY PRACTICE
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3863
Practice Address - Country:US
Practice Address - Phone:904-633-0560
Practice Address - Fax:904-633-0561
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000760999AMedicaid
FL0403393-00Medicaid
GA000760999AMedicaid
FL0403393-00Medicaid
FL05746YMedicare PIN
FL05746WMedicare PIN