Provider Demographics
NPI:1063790038
Name:DR CHARLES PITTLE DPM PLLC
Entity type:Organization
Organization Name:DR CHARLES PITTLE DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:915-598-3338
Mailing Address - Street 1:1225 E CLIFF DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4732
Mailing Address - Country:US
Mailing Address - Phone:915-598-3338
Mailing Address - Fax:915-598-3339
Practice Address - Street 1:1225 E CLIFF DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4732
Practice Address - Country:US
Practice Address - Phone:915-598-3338
Practice Address - Fax:915-598-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
TX1643261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1643OtherDPM LICENSE #