Provider Demographics
NPI:1053309997
Name:HUGHES, CHARLES VON ODEN III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:VON ODEN
Last Name:HUGHES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A JOHN DUPRE DR
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116A JOHN DUPRE DR
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336
Practice Address - Country:US
Practice Address - Phone:806-894-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115591104OtherFIRSTCARE
TXMDG2997OtherWORKERS COMP
TX119658OtherSUPERIOR HEALTH PLAN
TX130236601Medicaid
5086025OtherAETNA
TX115591104OtherFIRSTCARE
TXMDG2997OtherWORKERS COMP