Provider Demographics
NPI:1518193358
Name:NALLEY, CHARLES C (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:NALLEY
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 1:603 7TH ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:727-553-3525
Mailing Address - Fax:727-553-7432
Practice Address - Street 1:603 7TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4719
Practice Address - Country:US
Practice Address - Phone:727-553-3525
Practice Address - Fax:727-553-7432
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132488207XS0117X, 207XS0117X
ARE9001207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021610300Medicaid
AR5MM65OtherBLUE CROSS BLUE SHIELD
AR211202001Medicaid