Provider Demographics
NPI:1275854465
Name:FILLINGANE, CHARLES S II (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:FILLINGANE
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:FILLINGANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2336 S MAIN ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-3622
Mailing Address - Country:US
Mailing Address - Phone:660-220-2123
Mailing Address - Fax:660-562-7911
Practice Address - Street 1:2336 S MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3622
Practice Address - Country:US
Practice Address - Phone:660-220-2123
Practice Address - Fax:660-562-7911
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8941207Q00000X
TXP7438207Q00000X
MO2016039415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty