Provider Demographics
NPI:1114969219
Name:DEUR, CHARLES JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAY
Last Name:DEUR
Suffix:
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:801 ROAD TO SIX FLAGS W
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2616
Practice Address - Country:US
Practice Address - Phone:817-274-6532
Practice Address - Fax:817-548-8744
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4804207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131943602Medicaid
TX8R1426OtherBLUE CROSS OF TEXAS
TX131943604Medicaid
TX131943605OtherCSHCN
TX131943601Medicaid
TX131943607Medicaid
TX131943601Medicaid
TX131943607Medicaid
TX85M518Medicare PIN
TX8R1426OtherBLUE CROSS OF TEXAS
TX131943602Medicaid
TX830001333Medicare PIN