Provider Demographics
NPI:1396735999
Name:MILD, CHARLES F (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:MILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 PEASE ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8348
Mailing Address - Country:US
Mailing Address - Phone:956-421-5111
Mailing Address - Fax:956-421-5221
Practice Address - Street 1:2121 PEASE ST
Practice Address - Street 2:SUITE 407
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8348
Practice Address - Country:US
Practice Address - Phone:956-421-5111
Practice Address - Fax:956-421-5221
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6895207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120333302Medicaid
TX82186KMedicare PIN