Individual
DR. CHARLES C BOACKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
513 BROOKWOOD BLVD, SUITE 50, BIRMINGHAM, AL 35209-6862
(205) 877-2761
(205) 877-2399
Mailing address
513 BROOKWOOD BLVD, SUITE 50, BIRMINGHAM, AL 35209-6862
(205) 877-2761
(205) 877-2399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10381
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009960790
—
AL
01
—
110224927
RAILROAD MEDICARE
—
01
—
631266801 0054
CIGNA
—
01
—
C73058
VIVA
—
Enumeration date
08/30/2006
Last updated
02/06/2023
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