Provider Demographics
NPI:1932183464
Name:RAPE, CHARLES DARREN (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DARREN
Last Name:RAPE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3105 WALNUT CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7916
Mailing Address - Country:US
Mailing Address - Phone:817-326-2750
Mailing Address - Fax:
Practice Address - Street 1:1308 PALUXY RD STE 203E
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5689
Practice Address - Country:US
Practice Address - Phone:817-579-7246
Practice Address - Fax:817-579-3916
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q50978Medicare UPIN
TX411130YVTSMedicare PIN