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NPI Code Detail

MEDICARE: CHARLES D FOUTZ MD

MEDICARE: CHARLES D FOUTZ 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
1207P00000XEmergency Medicine PhysicianE0918TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28R9680OTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1356390298
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES D FOUTZ MD
Provider Business Mailing Address
First Line : PO BOX 8730
Second Line :
City : FORT WORTH
State : TX
Zip : 76124-0730
Country : US
Telephone Number : 817-451-4208
Fax Number :
Provider Business Practice Location Address
First Line : 2555 JIMMY JOHNSON BLVD
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77640-2007
Country : US
Telephone Number : 409-724-7389
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 07/08/2007

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