Provider Demographics
NPI:1073531158
Name:WHITTENBURG, CHARLES T (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:WHITTENBURG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATT. BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6309
Mailing Address - Fax:903-416-6310
Practice Address - Street 1:5012 US HWY 75
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-416-6309
Practice Address - Fax:903-416-6310
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1779207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150781602Medicaid
TX1507816Medicaid
TX150781603Medicaid
TXH45838Medicare UPIN
TX150781602Medicaid
TX1507816Medicaid
TXTXB150615Medicare PIN