Provider Demographics
NPI:1376043018
Name:VOGL, CHARLES RICHARD III
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:VOGL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 MAJESTIC EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6146
Mailing Address - Country:US
Mailing Address - Phone:352-617-0518
Mailing Address - Fax:
Practice Address - Street 1:2243 MAJESTIC EAGLE CIR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6146
Practice Address - Country:US
Practice Address - Phone:352-617-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician