Provider Demographics
NPI:1104053271
Name:SMARK, CHARLES T JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:SMARK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MERCY CIRCLE
Mailing Address - Street 2:DEPT OF ORTHOPEDICS
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-725-1619
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:DEPT OF ORTHOPEDICS
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2022-08-26
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Provider Licenses
StateLicense IDTaxonomies
NE25855207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery