Provider Demographics
NPI:1780668624
Name:SMITH, CHARLES R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1802
Mailing Address - Country:US
Mailing Address - Phone:806-293-5113
Mailing Address - Fax:806-296-7990
Practice Address - Street 1:2222 W 24TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1802
Practice Address - Country:US
Practice Address - Phone:806-293-5113
Practice Address - Fax:806-296-7990
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE98616Medicare UPIN
TX8642N0Medicare PIN