Provider Demographics
NPI:1659443851
Name:CHARLES H. WAHLERT MDPA
Entity Type:Organization
Organization Name:CHARLES H. WAHLERT MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WAHLERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-380-1985
Mailing Address - Street 1:521 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2705
Mailing Address - Country:US
Mailing Address - Phone:940-380-1985
Mailing Address - Fax:940-382-6728
Practice Address - Street 1:521 BRYAN ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2705
Practice Address - Country:US
Practice Address - Phone:940-380-1985
Practice Address - Fax:940-382-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27393Medicare UPIN