MEDICARE: CHARLES H MIMS 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	207RH0003X	Hematology & Oncology Physician	D4230	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D4230	OTHER	TX	STATE LICESNE

General Provider Information

NPI Number	:	1396717039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES H MIMS MD

Provider Business Mailing Address
First Line	:	4411 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3832
Country	:	US
Telephone Number	:	210-595-5326
Fax Number	:	210-614-8740

Provider Business Practice Location Address
First Line	:	4411 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3822
Country	:	US
Telephone Number	:	210-595-5326
Fax Number	:	210-614-8740

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/09/2007

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Directions to “ CHARLES H MIMS MD” Practice Location

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