Provider Demographics
NPI:1427137058
Name:CHARLES R PAJESTKA MD
Entity type:Organization
Organization Name:CHARLES R PAJESTKA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-387-6557
Mailing Address - Street 1:301A HUDSPETH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950
Mailing Address - Country:US
Mailing Address - Phone:325-387-6557
Mailing Address - Fax:325-387-5272
Practice Address - Street 1:301A HUDSPETH AVENUE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950
Practice Address - Country:US
Practice Address - Phone:325-387-6557
Practice Address - Fax:325-387-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DH41OtherBCBS
TX00576YMedicare ID - Type Unspecified
B25352Medicare UPIN