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Organization
CHARLOTTE ORTHOPAEDIC CLINIC PROFESSIONAL ASSOCIATION
Active
Organization
CHARLOTTE ORTHOPAEDIC CLINIC PROFESSIONAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH RENEE MCLURE (PRACTICE ADMINISTRATOR)
(941) 625-0984
Entity
Organization
Contact information
Practice address
4161 TAMIAMI TRL, UNIT 101, PORT CHARLOTTE, FL 33952-9204
(941) 625-0984
(941) 625-0877
Mailing address
4161 TAMIAMI TRL, UNIT 101, PORT CHARLOTTE, FL 33952-9204
(941) 625-0984
(941) 625-0877
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0886990001
PALMETTO
FL
01
—
1596302000
DEPT OF LABOR
FL
01
—
4639456
AETNA
FL
01
—
7323528-002
CIGNA-PAL
FL
01
—
77674
BLUE CROSS BLUE SHIELD
FL
01
—
DE0219
RR MEDICARE
FL
01
—
K2675
MEDICARE
FL
Enumeration date
05/08/2006
Last updated
08/05/2013
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