Individual
CHARLES SHANE MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5153 N 9TH AVE STE 207, PENSACOLA, FL 32504-5705
(850) 416-5050
(850) 416-5022
Mailing address
PO BOX 2699, PENSACOLA, FL 32513-2699
(850) 416-5050
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME8722
FL
Other
Enumeration date
09/03/2008
Last updated
12/06/2018
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