Provider Demographics
NPI:1649730391
Name:CHARLS, RICHY
Entity type:Individual
Prefix:
First Name:RICHY
Middle Name:
Last Name:CHARLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 ASPIRE BLVD APT 423
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3571
Mailing Address - Country:US
Mailing Address - Phone:214-783-5878
Mailing Address - Fax:
Practice Address - Street 1:3435 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5088
Practice Address - Country:US
Practice Address - Phone:903-737-0000
Practice Address - Fax:903-785-1277
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV7477207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program