Individual
LIZA N CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
19701 S TAMIAMI TRL, FORT MYERS, FL 33908-4818
(239) 314-1660
(239) 425-6404
Mailing address
PO BOX 919771, ORLANDO, FL 32891-9771
(239) 278-3600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME118536
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011911100
—
FL
Enumeration date
03/02/2012
Last updated
09/28/2020
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