Individual
DALE RAFAEL CHARNECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2055 PROFESSIONAL CENTER DR, ORANGE PARK, FL 32073-4461
(904) 276-4500
(904) 276-4160
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME15741
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16812Y
BCBS
FL
01
—
P00121400
RAILROAD MEDICARE
FL
Enumeration date
08/01/2005
Last updated
01/15/2008
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