Provider Demographics
NPI:1952432965
Name:CHARLES W. PROCHERA, MD FCCP PA
Entity Type:Organization
Organization Name:CHARLES W. PROCHERA, MD FCCP PA
Other - Org Name:PULMONARY & CRITICAL CARE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PROCHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-337-0036
Mailing Address - Street 1:816 KELLER PARKWAY
Mailing Address - Street 2:STE 102
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2479
Mailing Address - Country:US
Mailing Address - Phone:817-337-0036
Mailing Address - Fax:817-337-0053
Practice Address - Street 1:816 KELLER PKWY
Practice Address - Street 2:STE 102
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2479
Practice Address - Country:US
Practice Address - Phone:817-337-0036
Practice Address - Fax:817-337-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5706174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0057ZMedicare PIN
TXB25657Medicare UPIN
B25657Medicare UPIN