Basic Information
| Provider Information | |||||||||
| NPI: | 1033180104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBERT | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 INDIAN SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356342056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568103036 | ||||||||
| FaxNumber: | 2562653886 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 INDIAN SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356342056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568103036 | ||||||||
| FaxNumber: | 2562653886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 01/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 15691 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 15691 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00015691 | 01 | AL | LICENSE | OTHER | BA1103364 | 01 | AL | DEA | OTHER |