Provider Demographics
NPI:1740463314
Name:CHARLES P. GUERRIERO III, MD
Entity type:Organization
Organization Name:CHARLES P. GUERRIERO III, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRENITY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-368-6488
Mailing Address - Street 1:8315 WALNUT HILL LN STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4248
Mailing Address - Country:US
Mailing Address - Phone:214-368-6488
Mailing Address - Fax:214-368-3744
Practice Address - Street 1:8315 WALNUT HILL LN STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4248
Practice Address - Country:US
Practice Address - Phone:214-368-6488
Practice Address - Fax:214-368-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00708YMedicare PIN