Individual
DR. CHARLES C SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3435 E PONY EXPRESS PKWY STE 140, EAGLE MOUNTAIN, UT 84005-5548
(801) 893-8811
Mailing address
11300 NE 2ND AVENUE, MIAMI SHORES, FL 33161
(305) 693-7287
(305) 694-9616
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
9244891-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9244891-0501
MEDICAL LICENSE
UT
Enumeration date
09/20/2005
Last updated
04/24/2020
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