Provider Demographics
NPI:1841217437
Name:SAUNDERS, CHARLES GLENN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:GLENN
Last Name:SAUNDERS
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:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:1100 ORCHARD PLACE, SUITE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2519
Practice Address - Country:US
Practice Address - Phone:817-469-1001
Practice Address - Fax:817-469-6613
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00055217OtherRAILROAD MEDICARE
P00055217OtherRAILROAD MEDICARE
TX8A9420Medicare PIN