Individual
DR. CHARLES B. MCINTOSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3160 EDGEWOOD AVE W, JACKSONVILLE, FL 32209-2245
(904) 765-5804
(904) 765-0958
Mailing address
3160 EDGEWOOD AVE W, JACKSONVILLE, FL 32209-2245
(904) 765-5804
(904) 765-0958
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0006612
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0932138002
CIGNA
FL
01
—
1055089
HUMANA
FL
01
—
13123
HEALTHEASE
FL
01
—
16450
TRICARE
FL
01
—
4047696
AETNA
FL
Enumeration date
08/16/2006
Last updated
07/08/2007
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