Provider Demographics
NPI:1740269448
Name:ARBOGAST, CHARLES BRADLEY (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRADLEY
Last Name:ARBOGAST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-8122
Mailing Address - Fax:850-314-6152
Practice Address - Street 1:1110 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6742
Practice Address - Country:US
Practice Address - Phone:850-863-8122
Practice Address - Fax:850-314-6152
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13671207R00000X, 207RN0300X
GA069169207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016196500Medicaid
FLCKU3WOtherBCBSFL
FL016196500Medicaid