Provider Demographics
NPI:1184665952
Name:PAJESTKA, CHARLES RAY (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAY
Last Name:PAJESTKA
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 1:301A HUDSPETH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950
Mailing Address - Country:US
Mailing Address - Phone:325-387-6557
Mailing Address - Fax:325-387-5272
Practice Address - Street 1:301A HUDSPETH AVENUE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950
Practice Address - Country:US
Practice Address - Phone:325-387-6557
Practice Address - Fax:325-387-5272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DH41OtherBCBS
TX00576YMedicare ID - Type Unspecified
B25352Medicare UPIN