Provider Demographics
NPI:1508360041
Name:DELK, CHARLES DEE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DEE
Last Name:DELK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:SIMONTON
Mailing Address - State:TX
Mailing Address - Zip Code:77476-0721
Mailing Address - Country:US
Mailing Address - Phone:832-614-5983
Mailing Address - Fax:
Practice Address - Street 1:14635 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6559
Practice Address - Country:US
Practice Address - Phone:832-614-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies