Provider Demographics
NPI:1437542982
Name:CHARLES DAVID BRAUNGARDT
Entity Type:Organization
Organization Name:CHARLES DAVID BRAUNGARDT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRAUNGARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-999-0639
Mailing Address - Street 1:7221 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-5327
Mailing Address - Country:US
Mailing Address - Phone:817-999-0639
Mailing Address - Fax:
Practice Address - Street 1:7221 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-5327
Practice Address - Country:US
Practice Address - Phone:817-999-0639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty