Basic Information
| Provider Information | |||||||||
| NPI: | 1417182502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAWSETT | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ROBINSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 W. EIGHTH ST. BOX C506 | ||||||||
| Address2: | CLINICAL CENTER, 1ST FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443837 | ||||||||
| FaxNumber: | 9042444508 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 W. EIGHTH ST. | ||||||||
| Address2: | CLINICAL CENTER, 1ST FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443837 | ||||||||
| FaxNumber: | 9042444508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2009 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME112904 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.