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CHARLES A SLATTERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7455 S US HIGHWAY 1, TITUSVILLE, FL 32780-8115
(321) 264-2100
(321) 264-2485
Mailing address
7455 S US HIGHWAY 1, TITUSVILLE, FL 32780-8115
(321) 264-2100
(321) 264-2485

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0051997
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04843
BLUE SHIELD
FL
05
062108100
FL
01
110165605
RAILROAD MEDICARE
FL
01
ME0051997
MEDICAL LICENSE
FL
Enumeration date
06/06/2007
Last updated
03/12/2020
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