Provider Demographics
NPI:1669442703
Name:BUHRMAN JR., CHARLES M JR (PSYD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:BUHRMAN JR.
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 WOOD THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-2620
Mailing Address - Country:US
Mailing Address - Phone:859-291-4800
Mailing Address - Fax:
Practice Address - Street 1:500 DR MARTIN LUTHER KING JR ST N STE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1472
Practice Address - Country:US
Practice Address - Phone:727-357-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4324103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903777Medicaid
KY0999401Medicare PIN
OHBUCP15586Medicare PIN
OH0903777Medicaid
P00408757Medicare PIN