Provider Demographics
NPI:1366562522
Name:CHARLES M DEMPSEY MD PLC
Entity type:Organization
Organization Name:CHARLES M DEMPSEY MD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-678-5516
Mailing Address - Street 1:PO BOX 15689
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0122
Mailing Address - Country:US
Mailing Address - Phone:352-678-5516
Mailing Address - Fax:352-678-5518
Practice Address - Street 1:12228 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-2631
Practice Address - Country:US
Practice Address - Phone:352-678-5516
Practice Address - Fax:352-678-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82485208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9588Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER