Provider Demographics
NPI:1962707075
Name:CHARLES MAULDIN, MD PC
Entity type:Organization
Organization Name:CHARLES MAULDIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAULDIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-848-2161
Mailing Address - Street 1:PO BOX 14513
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65814-0513
Mailing Address - Country:US
Mailing Address - Phone:417-848-2161
Mailing Address - Fax:
Practice Address - Street 1:3003 E CHESTNUT EXPY STE 109
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2527
Practice Address - Country:US
Practice Address - Phone:417-865-0011
Practice Address - Fax:417-865-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6J282081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty