Provider Demographics
NPI:1083728711
Name:HOLMSTEN, CHARLES G (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:G
Last Name:HOLMSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096
Mailing Address - Country:US
Mailing Address - Phone:713-777-3131
Mailing Address - Fax:713-270-8105
Practice Address - Street 1:5895 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096
Practice Address - Country:US
Practice Address - Phone:713-777-3131
Practice Address - Fax:713-270-8105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6035261QX0100X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23561Medicare UPIN
TX00L31LMedicare ID - Type UnspecifiedGROUP NUMBER
TX84V645Medicare ID - Type UnspecifiedINDIVIDUAL