Provider Demographics
NPI:1659333771
Name:CHARLES, DARIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:LEE
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 W WHEATLAND RD
Mailing Address - Street 2:PAV III STE #360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4418
Mailing Address - Country:US
Mailing Address - Phone:214-884-4700
Mailing Address - Fax:214-884-4749
Practice Address - Street 1:1601 E DEBBIE LN
Practice Address - Street 2:STE#2109
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3674
Practice Address - Country:US
Practice Address - Phone:817-473-9125
Practice Address - Fax:817-473-9126
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176860803Medicaid
TX0092MTOtherBCBS
TX8A7728OtherBC/BS
TX1659333771Medicaid
TX8F4015Medicare PIN
TXP00379505Medicare PIN
TX1659333771Medicaid
TX612040Medicare PIN