Provider Demographics
NPI:1194945469
Name:SMALLWOOD, CHARLES A (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:SMALLWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:56 CRYSTAL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2830
Mailing Address - Country:US
Mailing Address - Phone:321-799-9862
Mailing Address - Fax:
Practice Address - Street 1:OMEHS
Practice Address - Street 2:CHS-005
Practice Address - City:KSC
Practice Address - State:FL
Practice Address - Zip Code:32899
Practice Address - Country:US
Practice Address - Phone:321-861-8630
Practice Address - Fax:321-867-9360
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL563662083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine