Individual
DR. CHARLES MARK MILLSAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 FARRELL CRESCENT, OWENSBORO, KY 42303
(270) 926-3297
(270) 926-7325
Mailing address
2845 FARRELL CRESCENT, OWENSBORO, KY 42303
(270) 926-3297
(270) 926-7325
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01043469A
IN
207W00000X
Ophthalmology Physician
Primary
30334
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000273547
ANTHEM
IN
05
—
100361620
—
IN
01
—
180018982
RAILROAD MEDICARE
—
05
—
64303340
—
KY
Enumeration date
06/09/2005
Last updated
12/23/2009
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