Provider Demographics
NPI:1629079199
Name:GOBERT, CHARLES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:GOBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2540 HIGHWAY 71 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-9201
Mailing Address - Country:US
Mailing Address - Phone:979-733-0238
Mailing Address - Fax:979-733-0178
Practice Address - Street 1:2540 HIGHWAY 71 S
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-9201
Practice Address - Country:US
Practice Address - Phone:979-733-0238
Practice Address - Fax:979-733-0178
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9071207Q00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00922WMedicare ID - Type Unspecified
TXG56521Medicare UPIN