Provider Demographics
NPI:1780683144
Name:PIPKIN, CHARLES STUART III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STUART
Last Name:PIPKIN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:18626 HARDY OAK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4228
Mailing Address - Country:US
Mailing Address - Phone:210-495-9047
Mailing Address - Fax:210-293-2930
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 212
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-657-6948
Practice Address - Fax:210-293-3908
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG5485207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122693802Medicaid
TXB63323Medicare UPIN
TX89J503Medicare PIN
TX0988520001Medicare NSC