Individual
DR. CHARLES W MACKETT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 27TH ST, VERO BEACH, FL 32960-0303
(772) 257-8224
(772) 252-3245
Mailing address
1555 INDIAN RIVER BLVD STE B210, VERO BEACH, FL 32960-7113
(772) 257-8224
(772) 252-3245
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD425999
PA
207Q00000X
Family Medicine Physician
Primary
ME107676
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101235908
—
PA
01
—
ME107676
MEDICAL LICENSE
FL
Enumeration date
02/15/2006
Last updated
02/12/2025
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