Healthcare Provider Details

I. General information

NPI: 1801850193
Provider Name (Legal Business Name): CHARLES M MYERS JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW 25TH AVE DEPT OF RADIOLOGY
MINERAL WELLS TX
76067-8246
US

IV. Provider business mailing address

PO BOX 1656
ALEDO TX
76008-1656
US

V. Phone/Fax

Practice location:
  • Phone: 940-325-7891
  • Fax: 940-328-6523
Mailing address:
  • Phone: 817-441-1826
  • Fax: 817-441-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM1959
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberM1959
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: