Provider Demographics
NPI:1245282797
Name:ANDERSON, CHARLES J (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:681 4TH AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5729
Mailing Address - Country:US
Mailing Address - Phone:239-920-5700
Mailing Address - Fax:239-920-5710
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 3030
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5743
Practice Address - Country:US
Practice Address - Phone:239-249-8996
Practice Address - Fax:239-431-5845
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-09-19
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Provider Licenses
StateLicense IDTaxonomies
FLME0075601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0075601OtherSTATE LICENSE
FLA17407Medicare UPIN