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NPI Code Detail

MEDICARE: CHARLES PATRICK THEIVAGT MD

MEDICARE: CHARLES PATRICK THEIVAGT 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
1207Y00000XOtolaryngology PhysicianM3764TX

General Provider Information

NPI Number : 1396840682
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES PATRICK THEIVAGT MD
Provider Business Mailing Address
First Line : PO BOX 749
Second Line :
City : PHARR
State : TX
Zip : 78577-1614
Country : US
Telephone Number : 956-362-7020
Fax Number : 956-362-7035
Provider Business Practice Location Address
First Line : 2101 S CYNTHIA ST STE A
Second Line :
City : MCALLEN
State : TX
Zip : 78503-1359
Country : US
Telephone Number : 956-362-7020
Fax Number : 956-362-7035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 09/09/2025

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