Active NPI
Phares Charles, PA
- Medical Physician Assistant
- Fort Myers, FL
National Provider Identifier
1962221283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 001884-PA
- Practice address
- 3822 Broadway Ste a
Fort Myers, FL 33901-8148 - Phone
- (239) 900-9170
- NPI assigned
- Oct 3, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 001884-PA | PR | Primary |
Addresses
Primary practice location
3822 Broadway Ste a
Fort Myers, FL 33901-8148
Mailing address
630 Royal Palm Dr
Lake Worth, FL 33460-4757
Phone (781) 535-2779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001884-PA | PR | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727913600000",
"number": "1962221283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 ROYAL PALM DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334604757",
"telephone_number": "781-535-2779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3822 BROADWAY STE A",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339018148",
"telephone_number": "239-900-9170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLES",
"first_name": "PHARES",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-03",
"last_updated": "2024-10-03",
"certification_date": "2024-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PR",
"license": "001884-PA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.