Provider Demographics
NPI:1801850193
Name:MYERS, CHARLES M JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1656
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1656
Mailing Address - Country:US
Mailing Address - Phone:817-441-1826
Mailing Address - Fax:817-441-1856
Practice Address - Street 1:400 SW 25TH AVE
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8246
Practice Address - Country:US
Practice Address - Phone:940-325-7891
Practice Address - Fax:940-328-6523
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM19592085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057NKOtherBLUE CROSS BLUE SHIELD TX
TXI37129Medicare UPIN
TX0057NKOtherBLUE CROSS BLUE SHIELD TX