Provider Demographics
NPI:1760443782
Name:MANNER, CHARLES E (M D)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:MANNER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2741
Mailing Address - Country:US
Mailing Address - Phone:713-800-0660
Mailing Address - Fax:713-827-1380
Practice Address - Street 1:2130 W HOLCOMBE BLVD
Practice Address - Street 2:10TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3304
Practice Address - Country:US
Practice Address - Phone:713-600-0900
Practice Address - Fax:713-600-0070
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1773207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4010662OtherAETNA PROVIDER #
85274NOtherBLUECHOICE SOLUTION
TX137449805Medicaid
2224612OtherBLUE LINK #
10014424OtherAMERICAID STAR
830005870OtherRAILROAD MEDICARE
25166OtherAMERIGROUP
TX137449802Medicaid
25166OtherAMERIGROUP
2224612OtherBLUE LINK #
TX137449805Medicaid