Provider Demographics
NPI:1285730705
Name:MITCHELL, CHARLES WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WALTER
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10308
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0308
Mailing Address - Country:US
Mailing Address - Phone:254-526-5970
Mailing Address - Fax:
Practice Address - Street 1:3816 S CLEAR CREEK RD
Practice Address - Street 2:SUITE E
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4400
Practice Address - Country:US
Practice Address - Phone:254-554-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026KVOtherBLUE CROSS
TX00109WMedicare ID - Type Unspecified