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Individual

CHARLES E WEBSTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
3475 S SUNCOAST BLVD, HOMOSASSA, FL 34448-2322
(352) 628-7671
(352) 628-9893
Mailing address
3475 S SUNCOAST BLVD, HOMOSASSA, FL 34448-2322
(352) 628-7671
(352) 628-9893

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1866
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
060476301
FL
01
591842276001
TRICARE
FL
Enumeration date
10/04/2006
Last updated
06/10/2008
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