MEDICARE: CHARLES E. EWOH M.D.

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	207R00000X	Internal Medicine Physician	64486	AZ
2	207R00000X	Internal Medicine Physician	27612	MS
3	208M00000X	Hospitalist Physician	Q1399	TX
4	207R00000X	Internal Medicine Physician	Q1399	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1D1318	OTHER	MS	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114994621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E. EWOH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-0205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-378-3699

Provider Business Practice Location Address
First Line	:	1307 8TH AVE STE 502
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4172
Country	:	US
Telephone Number	:	817-335-8478
Fax Number	:	817-882-9910

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	11/02/2022

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Directions to “ CHARLES E. EWOH M.D.” Practice Location

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