Provider Demographics
NPI:1063401925
Name:RICHARDSON, CHARLIE E (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2740 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4010
Mailing Address - Country:US
Mailing Address - Phone:850-552-0922
Mailing Address - Fax:850-553-6192
Practice Address - Street 1:309 NE MARION ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2511
Practice Address - Country:US
Practice Address - Phone:850-973-3456
Practice Address - Fax:850-973-9399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME30397208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery