Provider Demographics
NPI:1316136724
Name:XELLER, CHARLES FRED (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRED
Last Name:XELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 CABOT LAKES DR.
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77537
Mailing Address - Country:US
Mailing Address - Phone:713-527-9971
Mailing Address - Fax:713-527-0561
Practice Address - Street 1:3000 RICHMOND AVE.
Practice Address - Street 2:STE. 540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:713-527-9971
Practice Address - Fax:713-527-0561
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXMDH5651207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA93291Medicare UPIN