DR. CHARLES C SOUTHERLAND (NPI# 1306832944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306832944 |
| Entity Type | Individual |
| Full Name | DR. CHARLES C SOUTHERLAND |
| Credential | DPM |
| Practice Address |
3435 E Pony Express Pkwy Ste 140 Eagle Mountain UT 84005-5548 |
| Mailing Address |
11300 Ne 2nd Avenue Miami Shores FL 33161 |
| Practice Telephone | 8018938811 |
| Mailing Telephone | 3056937287 |
| Mailing Fax Number | 3056949616 |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2020-04-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
9244891-0501 | UT | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | MEDICAL LICENSE | 9244891-0501 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 16800 Nw 2nd Ave, #202, North Miami Beach, FL 33169 | 3056937287 | 3056949616 |
| 1973 N State St, Provo, UT 846041012 | 8013732499 | 8013735200 |
| 8822 S Redwood Rd Ste E121, West Jordan, UT 840885763 | 8012857060 | 8012857061 |
| Street Address |
3435 E PONY EXPRESS PKWY STE 140 |
| City | EAGLE MOUNTAIN |
| State | UT |
| Zip Code | 84005-5548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659991438 | Utah Podiatry Group PC | Podiatrist | 3435 E Pony Express Pkwy Ste 140, Eagle Mountain, UT 84005-5548 | 2020-04-21 |
| 1134750110 | Brooke Ludwig | Nurse Practitioner | 3435 E Pony Express Pkwy Ste 140, Eagle Mountain, UT 84005-5548 | 2020-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922573856 | Eagle Mountain Children's Dentistry Pllc | Clinic/Center | 3435 Pony Express Parkway Ste. 130, Eagle Mountain, UT 84005 | 2018-10-08 |
| 1437650157 | Michael Hogue | Emergency Medical Technician, Basic | 2036 E Harkers Way, Eagle Mountain, UT 84005 | 2018-02-27 |
| 1376050682 | Bell Adult Healthcare and Wellness Pllc | Nurse Practitioner | 4719 E Silver Creek Way, Eagle Mountain, UT 84005 | 2018-01-08 |
| 1891201794 | Breaking Barriers Therapy Services LLC | Speech-Language Pathologist | 3756 E Barton Creek Dr, Eagle Mountain, UT 84005 | 2017-12-14 |
| 1346770617 | Mallory Lynn Hansen | Speech-Language Pathologist | 8981 N Skye Loop, Eagle Mountain, UT 84005 | 2017-06-19 |
| 1609315480 | Pony Express Dental LLC | Clinic/Center | 1308 E. Eagle Mountain Blvd, Eagle Mountain, UT 84005 | 2017-02-14 |
| 1609130418 | Utah Addiction Centers | Substance Abuse Rehabilitation Facility | 2590 Prarie View Drive, Eagle Mountain, UT 84005 | 2012-06-26 |
| 1760763411 | Elizabeth A Pritt | Physician Assistant | 4095 E Pony Express Parkway, Suite 1, Eagle Mountain, UT 84005 | 2011-09-07 |
| 1902101587 | Benjamin Dean Jones | Social Worker | 4682 East Foxwood Drive, Eagle Mountain, UT 84005 | 2011-01-13 |
| 1407182892 | Jacob Chase Fowler | Pharmacist | 3435 E Pony Express Pkwy Ste 150, Eagle Mountain, UT 84005 | 2009-10-20 |
| Find all providers in zip 84005 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528409513 | Devin Tranter | Podiatrist | 3943 E Pony Express Pkwy, 110, Eagle Mountain, UT 84005-5541 | 2013-07-08 |
| 1659991438 | Utah Podiatry Group PC | Podiatrist | 3435 E Pony Express Pkwy Ste 140, Eagle Mountain, UT 84005-5548 | 2020-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033721303 | Stride Foot and Ankle Pllc | Podiatrist | 1365 W 1250 S Ste 101, Orem, UT 84058-2303 | 2020-08-18 |
| 1700369014 | Utah Podiatry Group PC | Podiatrist | 6321 S Redwood Rd Ste 102, Taylorsville, UT 84123-6799 | 2018-09-12 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| 1447773122 | Apex Foot and Ankle Institute | Podiatrist | 882 N Main St # 2, Richfield, UT 84701-1840 | 2017-07-25 |
| 1902328644 | Weston Charles Packard | Podiatrist | 1561 W 7000 S Ste 201, West Jordan, UT 84084-3556 | 2017-07-14 |
| 1053844753 | Elite Ankle and Foot Pllc | Podiatrist | 39 E Center Street, Gunnison, UT 84634 | 2017-04-10 |
| 1811341621 | Victor Kent Myers | Podiatrist | 754 S Main St Ste 3, St George, UT 84770-5505 | 2016-04-18 |
| 1598119463 | Landon Cameron | Podiatrist | 1490 E Foremaster Dr Ste 250, St George, UT 84790-4501 | 2016-04-18 |
| 1417338161 | Adam Bowen Wood | Podiatrist | 1248 E 90 N Ste 101, American Fork, UT 84003-2954 | 2015-06-17 |
| Find all providers with the same taxonomy | ||||
| City | EAGLE MOUNTAIN |
| Zip Code | 84005 |
Please comment or provide details below to improve the information on DR. CHARLES C SOUTHERLAND.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.