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Individual
MARISSA G CHARLES
Active
Individual
MARISSA G CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7101
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1994998-04
WELLMED MEDICAID
TX
01
—
386468YLPS
WELLMED MEDICARE
TX
Enumeration date
12/15/2008
Last updated
10/18/2016
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