Individual
CHARLES MANLEY CLODFELTER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931-3585
(321) 799-7111
Mailing address
PO BOX 2400, MELBOURNE, FL 32902-2400
(321) 837-3820
(321) 837-3654
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME0071159
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250653000
—
FL
01
—
32302
BCBS
FL
Enumeration date
01/13/2006
Last updated
09/11/2014
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