Healthcare Provider Details

I. General information

NPI: 1174702898
Provider Name (Legal Business Name): CHARLES ROBERT GOBERT, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 HIGHWAY 71 S SUITE 100
COLUMBUS TX
78934-9201
US

IV. Provider business mailing address

2540 HIGHWAY 71 S SUITE 100
COLUMBUS TX
78934-9201
US

V. Phone/Fax

Practice location:
  • Phone: 979-733-0238
  • Fax: 979-733-0178
Mailing address:
  • Phone: 979-733-0238
  • Fax: 979-733-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK9071
License Number StateTX

VIII. Authorized Official

Name: CHARLES ROBERT GOBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 979-733-0238