1871819292 NPI number — CHARLES R PAYERLE, DDS, MD, PLLC

Table of content: (NPI 1871819292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871819292 NPI number — CHARLES R PAYERLE, DDS, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES R PAYERLE, DDS, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1871819292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12001 SOUTH FWY
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
BURLESON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76028-7208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-568-6811
Provider Business Mailing Address Fax Number:
817-568-6813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12001 SOUTH FWY
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-7208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-568-6811
Provider Business Practice Location Address Fax Number:
817-568-6813
Provider Enumeration Date:
04/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PAYERLE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-568-6811

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  0023735 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780894170 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com