Individual
MR. PHARES CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3822 BROADWAY STE A, FORT MYERS, FL 33901-8148
(239) 900-9170
Mailing address
630 ROYAL PALM DR, LAKE WORTH, FL 33460-4757
(781) 535-2779
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001884-PA
PR
Other
Enumeration date
10/03/2024
Last updated
10/03/2024
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