Provider Demographics
NPI:1609833276
Name:CHARLES, BRANDON C (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:C
Last Name:CHARLES
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 1:705 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4742
Mailing Address - Country:US
Mailing Address - Phone:972-304-6400
Mailing Address - Fax:972-304-6455
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4742
Practice Address - Country:US
Practice Address - Phone:972-304-6400
Practice Address - Fax:972-304-6455
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127956408Medicaid
TXE28262Medicare UPIN
TX8G9022Medicare ID - Type Unspecified
TX8J9760Medicare PIN
TX00410XMedicare ID - Type Unspecified
TX127956406Medicaid