1821390204 NPI number — CHARLES WOODROW MCCURLEY IV MD

Table of content: CHARLES WOODROW MCCURLEY IV MD (NPI 1821390204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821390204 NPI number — CHARLES WOODROW MCCURLEY IV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCURLEY
Provider First Name:
CHARLES
Provider Middle Name:
WOODROW
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821390204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 OLD SAN ANTONIO RD
Provider Second Line Business Mailing Address:
STE 406
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-816-5800
Provider Business Mailing Address Fax Number:
830-816-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 OLD SAN ANTONIO RD
Provider Second Line Business Practice Location Address:
STE 406
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-816-5800
Provider Business Practice Location Address Fax Number:
830-816-5860
Provider Enumeration Date:
11/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  N7720 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081S0010X , with the licence number: N7720 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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