Organization
CHARLES C GREENE MD PHD PA
Active
Other names
Jacksonville ENT Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES C GREENE (OWNER)
(912) 691-5711
Entity
Organization
Contact information
Practice address
789 W DUVAL ST, LAKE CITY, FL 32055-3811
(904) 419-2054
Mailing address
PO BOX 864935, ORLANDO, FL 32886-4935
(904) 419-2054
(904) 419-2057
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
08/31/2012
Last updated
06/04/2013
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