Individual
CHARLES C GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11512 LAKE MEAD AVE, SUITE 531, JACKSONVILLE, FL 32256-9680
(904) 419-2054
(904) 419-2057
Mailing address
11512 LAKE MEAD AVE UNIT 531, JACKSONVILLE, FL 32256-9733
(904) 419-2054
(904) 419-2057
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME82871
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264139900
—
FL
Enumeration date
07/03/2006
Last updated
08/03/2022
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