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Individual
DR. CHARLES C MAULDIN JR.
Active
Individual
DR. CHARLES C MAULDIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MDR6J28
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19288
BLUE CROSS/BLUE SHIELD
MO
05
—
202697900
—
MO
01
—
2079425
FIRST HEALTH
MO
01
—
26D1025378
CLIA
MO
01
—
43151887165802A005
TRIWEST
MO
01
—
9378408
PHCS
MO
01
—
ACS#140740000
US POSTAL SERVICE
MO
Enumeration date
08/24/2005
Last updated
09/27/2007
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