MEDICARE: CHARLES VON ODEN HUGHES III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G2997	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	115591104	OTHER	TX	FIRSTCARE
2	MDG2997	OTHER	TX	WORKERS COMP
3	119658	OTHER	TX	SUPERIOR HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5086025	OTHER		AETNA

General Provider Information

NPI Number	:	1053309997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES VON ODEN HUGHES III MD

Provider Business Mailing Address
First Line	:	116A JOHN DUPRE DR
Second Line	:
City	:	LEVELLAND
State	:	TX
Zip	:	79336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116A JOHN DUPRE DR
Second Line	:
City	:	LEVELLAND
State	:	TX
Zip	:	79336
Country	:	US
Telephone Number	:	806-894-7900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/13/2007

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