| Dr Charles C Southerland, DPM | |
|
3435 E Pony Express Pkwy Ste 140, Eagle Mountain, UT 84005-5548 | |
| (801) 893-8811 | |
| Not Available |
| Full Name | Dr Charles C Southerland |
|---|---|
| Gender | Male |
| Speciality | Podiatrist - Foot & Ankle Surgery |
| Location | 3435 E Pony Express Pkwy Ste 140, Eagle Mountain, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306832944 | NPI | - | NPPES |
| 9244891-0501 | Other | UT | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | 9244891-0501 (Utah) | Primary |
| Provider Name | Barry University Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1295959625 PECOS PAC ID: 3870499718 Enrollment ID: O20031210000902 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Charles C Southerland, DPM 11300 Ne 2nd Avenue, Miami Shores, FL 33161 Ph: (305) 693-7287 | Dr Charles C Southerland, DPM 3435 E Pony Express Pkwy Ste 140, Eagle Mountain, UT 84005-5548 Ph: (801) 893-8811 |
Dr. Devin Tranter, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 3943 E Pony Express Pkwy, 110, Eagle Mountain, UT 84005 Phone: 801-789-4488 | |
Utah Podiatry Group Llc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 3435 E Pony Express Pkwy Ste 140, Eagle Mountain, UT 84005 Phone: 801-789-2444 |