Provider Demographics
NPI:1487195608
Name:MEDERT, CHARLES MAXWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MAXWELL
Last Name:MEDERT
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 1:2700 BEE CAVES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5642
Mailing Address - Country:US
Mailing Address - Phone:512-250-2020
Mailing Address - Fax:
Practice Address - Street 1:2700 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5642
Practice Address - Country:US
Practice Address - Phone:512-250-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.159124207W00000X
TXU2087207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology