Provider Demographics
NPI:1700870532
Name:LUXENBERG, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:LUXENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2595 TAMPA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3152
Mailing Address - Country:US
Mailing Address - Phone:727-785-6777
Mailing Address - Fax:727-785-7102
Practice Address - Street 1:2595 TAMPA RD
Practice Address - Street 2:SUITE A
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3152
Practice Address - Country:US
Practice Address - Phone:727-785-6777
Practice Address - Fax:727-785-7102
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0035503207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0035503OtherFL STATE
FLME0035503OtherFL STATE
FLME0035503OtherFL STATE
FLD57415Medicare UPIN