Provider Demographics
NPI:1871572164
Name:GREMILLION, CHARLES M JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:GREMILLION
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 S MCCALL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-5137
Mailing Address - Country:US
Mailing Address - Phone:941-460-9159
Mailing Address - Fax:941-460-9419
Practice Address - Street 1:2400 S MCCALL RD
Practice Address - Street 2:SUITE A
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-5137
Practice Address - Country:US
Practice Address - Phone:941-460-9159
Practice Address - Fax:941-460-9419
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-05-09
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Provider Licenses
StateLicense IDTaxonomies
FL57634207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0569437Medicaid
B62546Medicare UPIN
FL0569437Medicaid