Provider Demographics
NPI:1659592012
Name:CALVERT, CHARLES WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:CALVERT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:546 E SANDY LAKE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5786
Mailing Address - Country:US
Mailing Address - Phone:972-258-7426
Mailing Address - Fax:972-870-4926
Practice Address - Street 1:546 E SANDY LAKE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5786
Practice Address - Country:US
Practice Address - Phone:972-258-7426
Practice Address - Fax:972-870-4926
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM6063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197724103Medicaid
TX368267YZNAOtherMEDICARE