Organization
CHARLOTTE ORTHOPAEDIC CLINIC PROFESSIONAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH RENEE MCLURE (PRACTICE ADMINISTRATOR)
(941) 625-0984
Entity
Organization
Contact information
Practice address
4161 TAMIAMI TRL, UNIT 101, PORT CHARLOTTE, FL 33952-9204
(941) 625-0984
(941) 625-0877
Mailing address
4161 TAMIAMI TRL, UNIT 101, PORT CHARLOTTE, FL 33952-9204
(941) 625-0984
(941) 625-0877
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0886990001
PALMETTO
FL
01
—
1596302000
DEPT OF LABOR
FL
01
—
4639456
AETNA
FL
01
—
7323528-002
CIGNA-PAL
FL
01
—
77674
BLUE CROSS BLUE SHIELD
FL
01
—
DE0219
RAILROAD MEDICARE
FL
01
—
K2675
MEDICARE
FL
Enumeration date
05/08/2006
Last updated
08/05/2013
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