Provider Demographics
NPI:1700954898
Name:ALEXANDER, CHARLES DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DALE
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8729 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6890
Mailing Address - Country:US
Mailing Address - Phone:512-467-2914
Mailing Address - Fax:512-450-1392
Practice Address - Street 1:8729 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6890
Practice Address - Country:US
Practice Address - Phone:512-467-2914
Practice Address - Fax:512-450-1392
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD4905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12683Medicare UPIN