Provider Demographics
NPI:1306820949
Name:LINDSEY, CHARLES ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALFRED
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:ALFRED
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3200 RED RIVER ST
Mailing Address - Street 2:210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2655
Mailing Address - Country:US
Mailing Address - Phone:512-472-3161
Mailing Address - Fax:512-476-4309
Practice Address - Street 1:3200 RED RIVER ST
Practice Address - Street 2:210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2655
Practice Address - Country:US
Practice Address - Phone:512-472-3161
Practice Address - Fax:512-476-4309
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111528901Medicaid
TX00EA50OtherBCBS
TX00EA50Medicare PIN
TX111528901Medicaid