Provider Demographics
NPI:1336112978
Name:BILTZ, CHARLES I (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:I
Last Name:BILTZ
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 1:401 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2415
Mailing Address - Country:US
Mailing Address - Phone:903-872-3005
Mailing Address - Fax:903-872-3050
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:SUITE 195
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2471
Practice Address - Country:US
Practice Address - Phone:903-872-3005
Practice Address - Fax:903-874-5198
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD3823207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AL348OtherBLUECROSS BLUESHIELD
TX124090506Medicaid
TX00Y226OtherMEDICARE GROUP
B21281Medicare UPIN
TX124090506Medicaid