Individual
CHARLES L DOMSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
212 N 2ND ST, LEESBURG, FL 34748-5103
(352) 435-0723
(352) 435-0724
Mailing address
212 N 2ND ST, LEESBURG, FL 34748-5103
(352) 435-0723
(352) 435-0724
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME73019
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256714802
—
FL
Enumeration date
11/02/2005
Last updated
06/04/2015
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