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General NPI Number Information
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NPI Number | 1437104585
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Entity Type | Individual
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Provider Name | CHARLES WADE PAGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1303 RAGUET ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4249
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Country | US
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Telephone | 936-568-9600
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Fax | 936-568-9621
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Provider Business Mailing Address
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Address Line | 1303 RAGUET ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4249
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Country | US
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Telephone | 936-568-9600
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Fax | 936-568-9621
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K7468
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License Number State | TX
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