Provider Demographics
NPI:1154357523
Name:NATALIZIO, CHARLES FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANK
Last Name:NATALIZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4552 EMERSON DR
Mailing Address - Street 2:PLANO
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7225
Mailing Address - Country:US
Mailing Address - Phone:972-596-9154
Mailing Address - Fax:
Practice Address - Street 1:1405 W JEFFERSON ST
Practice Address - Street 2:WAXAHACHIE
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2231
Practice Address - Country:US
Practice Address - Phone:972-923-7144
Practice Address - Fax:972-923-7145
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200107501Medicaid
TX122421402Medicaid
TX122421408Medicaid
TXTXB127115Medicare PIN
TX0098BCMedicare ID - Type Unspecified
TX0A0236Medicare PIN
TX122421402Medicaid
TX200107501Medicaid