Individual
MR. CHARLES ALBERT TOLLETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
407 E 22ND ST, HUNTINGBURG, IN 47542-8964
(812) 683-6339
(812) 683-6337
Mailing address
P O BOX 327, HUNTINGBURG, IN 47542-0327
(812) 683-6339
(812) 683-6337
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01042157
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000238257
ANTHEM
IN
05
—
1004142200
—
IN
Enumeration date
11/15/2006
Last updated
08/19/2011
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