Healthcare Provider Details

I. General information

NPI: 1497700785
Provider Name (Legal Business Name): CHARLES P ISBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 S BROADWAY AVE
TYLER TX
75703-1335
US

IV. Provider business mailing address

1406 COLLEGE DR 1
TEXARKANA TX
75503-3580
US

V. Phone/Fax

Practice location:
  • Phone: 903-581-1601
  • Fax:
Mailing address:
  • Phone: 903-614-7693
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ0014
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: