Individual
CHARLES EDWARD FLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10301 HAGEN RANCH RD, SUITE C130, BOYNTON BEACH, FL 33437
(561) 736-7313
(561) 736-2309
Mailing address
1300 SAWGRASS CORPORATE PKWY STE 200, SUNRISE, FL 33323-2823
(800) 243-3839
(855) 527-5510
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
0101273176
VA
2088P0231X
Pediatric Urology Physician
ME59937
FL
2088P0231X
Pediatric Urology Physician
TP103
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054273300
—
FL
01
—
103690
AVMED
FL
01
—
12475
BCBS
FL
01
—
1755943
CIGNA
FL
01
—
2032607
AETNA HMO
FL
01
—
204200
AMERIGROUP
FL
01
—
26943
WELLCARE
FL
01
—
4611456
AETNA NON-HMO
FL
01
—
5962
NHP
FL
Enumeration date
02/14/2006
Last updated
03/24/2025
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