Provider Demographics
NPI:1629068788
Name:MONDAY, CHARLES WOODROW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WOODROW
Last Name:MONDAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4942
Mailing Address - Country:US
Mailing Address - Phone:936-295-9101
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4942
Practice Address - Country:US
Practice Address - Phone:936-295-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3345208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115078103Medicaid
TX115078103Medicaid
TX00J151Medicare ID - Type Unspecified