Provider Demographics
NPI:1992728802
Name:DEWBERRY, CHARLES T (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:DEWBERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1450 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4505
Mailing Address - Country:US
Mailing Address - Phone:855-353-7546
Mailing Address - Fax:863-294-2767
Practice Address - Street 1:931 S US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-6860
Practice Address - Country:US
Practice Address - Phone:855-353-7546
Practice Address - Fax:863-294-2767
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8732207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273378100Medicaid
FL273378100Medicaid