Provider Demographics
NPI:1750352449
Name:PITTLE, CHARLES I (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:PITTLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E CLIFF DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4700
Mailing Address - Country:US
Mailing Address - Phone:915-598-3338
Mailing Address - Fax:915-598-3339
Practice Address - Street 1:1225 E CLIFF DR STE 2A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4700
Practice Address - Country:US
Practice Address - Phone:915-598-3338
Practice Address - Fax:915-598-3339
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1643213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161069301Medicaid
0060AZMedicare ID - Type Unspecified
TX161069301Medicaid