Provider Demographics
NPI:1811992407
Name:ERCK, CHARLES S (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:ERCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIVER NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1803
Mailing Address - Country:US
Mailing Address - Phone:254-968-6051
Mailing Address - Fax:254-968-4204
Practice Address - Street 1:150 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1803
Practice Address - Country:US
Practice Address - Phone:254-968-6051
Practice Address - Fax:254-968-4204
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112329100OtherFIRST CARE PROVIDER NUMBE
TX129363501OtherUNITED HEALTHCARE PROV NO
TX83J075OtherBCBS PROVIDER NUMBER
TX7675525001OtherCIGNA PROVIDER NUMBER
TX136752602Medicaid
TX4620657OtherAETNA PROVIDER NUMBER
TX930033133OtherRAILROAD MEDICARE
TX136752602Medicaid
TX112329100OtherFIRST CARE PROVIDER NUMBE
TX7675525001OtherCIGNA PROVIDER NUMBER