# DR. CHARLES C MAULDIN JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1194718270
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | MDR6J28 | MO | Yes |

## Other

- **Enumeration date:** 08/24/2005
- **Last updated:** 09/27/2007

## 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 |