Provider Demographics
NPI:1457374225
Name:STRAUSS, CHARLES ERNEST (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERNEST
Last Name:STRAUSS
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 COUNTRY CLUB DR # A
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1614
Mailing Address - Country:US
Mailing Address - Phone:361-579-9536
Mailing Address - Fax:
Practice Address - Street 1:5505 COUNTRY CLUB DR # A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1614
Practice Address - Country:US
Practice Address - Phone:361-579-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD18262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00JR946Medicaid
TXP00JR946Medicaid
TX00JR94Medicare ID - Type Unspecified