MEDICARE: DR. RONALD A CHARLES 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	207P00000X	Emergency Medicine Physician	24830	OK
2	207P00000X	Emergency Medicine Physician	J0811	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1770590531	OTHER	TX	BCBSTX
3	1770590531	OTHER	TX	TRICARE

General Provider Information

NPI Number	:	1770590531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD A CHARLES MD

Provider Business Mailing Address
First Line	:	2951 MARINA BAY DR
Second Line	:	SUITE 130, #145
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2735
Country	:	US
Telephone Number	:	832-758-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-4208
Country	:	US
Telephone Number	:	832-582-8379
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	06/06/2014

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