Provider Demographics
NPI:1245494822
Name:ELDRIDGE, CHARLES DAVID III (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:ELDRIDGE
Suffix:III
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 1:2025 SOQUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2000
Practice Address - Country:US
Practice Address - Phone:831-458-6272
Practice Address - Fax:831-458-6276
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC29613207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33970Medicare UPIN