Provider Demographics
NPI:1730168808
Name:REESE, CHARLES ALLEN (MD, PHD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALLEN
Last Name:REESE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HULSE RD
Mailing Address - Street 2:NAMI ENT DEPT
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1047
Mailing Address - Country:US
Mailing Address - Phone:850-452-2257
Mailing Address - Fax:
Practice Address - Street 1:340 HULSE RD
Practice Address - Street 2:NAMI ENT DEPT
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-1047
Practice Address - Country:US
Practice Address - Phone:850-452-2257
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 53705207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology