MEDICARE: CHARLES WILLIAM DOUBLEDAY 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	207N00000X	Dermatology Physician	F9375	TX

General Provider Information

NPI Number	:	1508869991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES WILLIAM DOUBLEDAY MD

Provider Business Mailing Address
First Line	:	1235 WYNDEN COMMONS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-2538
Country	:	US
Telephone Number	:	713-501-1044
Fax Number	:	713-627-1782

Provider Business Practice Location Address
First Line	:	3 RIVERWAY STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1922
Country	:	US
Telephone Number	:	713-501-1044
Fax Number	:	713-627-1782

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/17/2023

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