Doctor Name: | CHARLES HENRY DELAWARE |
NPI Number: | 1043272008 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA1968 |
Business Practice Address: | 5518 Manatee Point Dr New Port Richey, FL - 346521434 |
Business Phone Number: | 7273921981 |
Business Fax Number: | |
Mailing Address: | 5518 Manatee Point Dr, NEW PORT RICHEY |
State: | FL |
Postal Code: | 346521434 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | PA1968 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |