Provider Demographics
NPI:1871591388
Name:KING, CHARLES TOWNSEND (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:TOWNSEND
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4118
Mailing Address - Country:US
Mailing Address - Phone:352-861-0440
Mailing Address - Fax:352-861-1869
Practice Address - Street 1:2850 SE THIRD COURT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4118
Practice Address - Country:US
Practice Address - Phone:352-732-6474
Practice Address - Fax:352-732-7205
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047557200Medicaid
FL047557200Medicaid
FL05611Medicare ID - Type Unspecified
FL1082390001Medicare NSC