Provider Demographics
NPI:1972796712
Name:HUOT, CHARISSE JEANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:JEANINE
Last Name:HUOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARISSE
Other - Middle Name:JEANINE
Other - Last Name:RECORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:807 N MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4254
Mailing Address - Country:US
Mailing Address - Phone:727-467-2400
Mailing Address - Fax:727-467-2477
Practice Address - Street 1:807 N MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4254
Practice Address - Country:US
Practice Address - Phone:727-467-2400
Practice Address - Fax:727-467-2477
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002590300Medicaid
FLP00915752OtherMEDICARE RAILROAD PROVIDER NUMBER
FL002590300Medicaid