Individual
CHARLES JOSEPH CLANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1005 MAR WALT DR, IMMEDIATE CARE DEPARTMENT, FORT WALTON BEACH, FL 32547-6707
(850) 863-8219
(850) 863-8249
Mailing address
1005 MAR WALT DRIVE, IMMEDIATE CARE DEPARTMENT, FORT WALTON BEACH, FL 32547-6796
(850) 863-8219
(850) 863-8249
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA9103700
FL
363A00000X
Physician Assistant
Primary
PA9103700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292457900
—
FL
Enumeration date
06/02/2006
Last updated
11/15/2010
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