Individual
CHARLES RUSSELL KOVALESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 HARRISON AVE, PANAMA CITY, FL 32405-4542
(850) 769-1668
(850) 785-2123
Mailing address
1900 HARRISON AVE, PANAMA CITY, FL 32405-4542
(850) 769-1668
(850) 785-2123
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME36420
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039443200
—
FL
01
—
99500
BCBS
—
Enumeration date
12/07/2005
Last updated
05/28/2025
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