Provider Demographics
NPI:1992123426
Name:COLLIE, CHARLTON EASTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLTON
Middle Name:EASTON
Last Name:COLLIE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9800 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4039
Mailing Address - Country:US
Mailing Address - Phone:954-755-5504
Mailing Address - Fax:954-755-7052
Practice Address - Street 1:9800 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4039
Practice Address - Country:US
Practice Address - Phone:954-755-5504
Practice Address - Fax:954-755-7052
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME147220207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine