Provider Demographics
NPI:1396840682
Name:THEIVAGT, CHARLES P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:THEIVAGT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 S CYNTHIA ST
Mailing Address - Street 2:PLEX A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1294
Mailing Address - Country:US
Mailing Address - Phone:956-687-7896
Mailing Address - Fax:956-994-9694
Practice Address - Street 1:2101 S CYNTHIA ST
Practice Address - Street 2:PLEX A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1294
Practice Address - Country:US
Practice Address - Phone:956-687-7896
Practice Address - Fax:956-994-9694
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-06-15
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Provider Licenses
StateLicense IDTaxonomies
TXM3764207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology