CHARLES SHANE MEDLOCK (NPI# 1619125671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619125671 |
| Entity Type | Individual |
| Full Name | CHARLES SHANE MEDLOCK |
| Credential | MD |
| Practice Address |
5153 N 9th Ave Ste 207 Pensacola FL 32504-5705 |
| Mailing Address |
Po Box 2699 Pensacola FL 32513-2699 |
| Practice Telephone | 8504165050 |
| Practice Fax Number | 8504165022 |
| Mailing Telephone | 8504165050 |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2018-12-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | ME8722 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
5153 N 9TH AVE STE 207 |
| City | PENSACOLA |
| State | FL |
| Zip Code | 32504-5705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518458454 | Melissa Anne Shaw | Nurse Practitioner | 5153 N 9th Ave Ste 207, Pensacola, FL 32504-5705 | 2018-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659978393 | Quinyatta Stride | Behavior Technician | 2511 Creighton Rd., Pensacola, FL 32504 | 2020-10-06 |
| 1962017657 | Pt Solutions of Pensacola LLC | Occupational Therapist | 2114 Creighton Rd, Ste C, Pensacola, FL 32504 | 2020-09-10 |
| 1982226742 | Elevate Behavioral Solutions | Behavioral Analyst | 4045 Renoir St, Pensacola, FL 32504 | 2020-05-14 |
| 1760021349 | Veteran Evaluations of Florida | Internal Medicine | 2411 Executive Plaza Drive, Suite A, Pensacola, FL 32504 | 2019-12-31 |
| 1215575527 | First City Health LLC | Pharmacy | 6005 College Parkway, Suite 1, Pensacola, FL 32504 | 2019-12-17 |
| 1184261158 | Claire Ann Letendre | Audiologist | 5153 N 9th Ave Pediatric Off Building, Pensacola, FL 32504 | 2019-12-09 |
| 1083275101 | Benjamin Mcmillon | Chiropractor | 2629 Creighton Road, Suite 1, Pensacola, FL 32504 | 2019-06-28 |
| 1407342595 | Faryal Munir | Student in an Organized Health Care Education/Training Program | Uf Pediatric Residency 5151 North 9th Ave, 6th Floor Nemours, Pensacola, FL 32504 | 2018-07-02 |
| 1497252050 | Sibyl Tenille Page | Nurse Practitioner | 5147 N 9th Ave Ste 322, Pensacola, FL 32504 | 2018-04-10 |
| 1396272589 | Sacred Heart Hospital | General Acute Care Hospital | 2552 Carmel Heights Rd, Pensacola, FL 32504 | 2017-05-18 |
| Find all providers in zip 32504 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184070823 | Jason Gronert | Obstetrics & Gynecology | 8333 N Davis Hwy # 2, Pensacola, FL 32514-6050 | 2016-05-12 |
| 1124447263 | Victor Hultstrand LLC | Obstetrics & Gynecology | 4724 N Davis Hwy # 200, Pensacola, FL 32503-2339 | 2014-04-15 |
| 1508184276 | Integrity Medical Care, LLC | Obstetrics & Gynecology | 6770 N 9th Ave, Pensacola, FL 32504-7346 | 2010-05-05 |
| 1366452815 | Carlos Arauco | Obstetrics & Gynecology | 1657 Trinity Dr, Pensacola, FL 32504-5708 | 2006-08-08 |
| 1487662326 | Nicholas Emmrick Sholty | Obstetrics & Gynecology | 4707 N Davis Hwy, Pensacola, FL 32503 | 2006-08-04 |
| 1831143940 | Julie A Decesare | Obstetrics & Gynecology | 8333 N Davis Hwy Fl 7, Pensacola, FL 32514-6050 | 2006-05-22 |
| 1245210046 | Paul E Larose | Obstetrics & Gynecology | 525 Brent Ln, Pensacola, FL 32503-2003 | 2006-01-18 |
| 1578540027 | Dean Edmund Altenhofen | Obstetrics & Gynecology | 6110 N Davis Hwy, Pensacola, FL 32504-6950 | 2005-12-27 |
| 1285618629 | Donna C. Bennett, Md, Pa | Obstetrics & Gynecology | 4220 N Davis Hwy, Building A, Suite 100, Pensacola, FL 32503-2752 | 2005-11-30 |
| 1942283890 | Robert W Andrews | Obstetrics & Gynecology | 525 Brent Lane, Pensacola, FL 32503 | 2005-11-23 |
| Find all providers in PENSACOLA | ||||
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| 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.