Provider Demographics
NPI:1093986762
Name:LEROY CHARLES MD PA
Entity type:Organization
Organization Name:LEROY CHARLES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-784-7014
Mailing Address - Street 1:12957 PALMS WEST DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4932
Mailing Address - Country:US
Mailing Address - Phone:561-784-7014
Mailing Address - Fax:561-784-7922
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4932
Practice Address - Country:US
Practice Address - Phone:561-784-7014
Practice Address - Fax:561-784-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83408207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265747300Medicaid
FL265747300Medicaid
FLA67802Medicare UPIN