Individual
MR. CHARLES LEE HARKNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2627 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4712
(904) 308-7372
(904) 308-2998
Mailing address
2627 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4712
(904) 308-7372
(904) 308-2998
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS0004463
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231069
HEALTHEASE
FL
01
—
2449678-004
CIGNA
FL
01
—
4047634
AETNA
FL
01
—
82507
BCBS
FL
Enumeration date
08/22/2005
Last updated
07/08/2007
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