Provider Demographics
NPI:1922131689
Name:DANGERFIELD, CHARLES JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:DANGERFIELD
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 LAKES AT 610 DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2403
Mailing Address - Country:US
Mailing Address - Phone:713-873-2626
Mailing Address - Fax:
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:BEN TAUB GENERAL HOSPITAL EMERGENCY CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-256-0232
Practice Address - Fax:713-873-2325
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103003Medicare PIN