Individual
CHARLES O SHOETAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7048 BISSONNET ST, HOUSTON, TX 77074-6010
(713) 776-3906
Mailing address
1901 AUGUSTA DR, # 308, HOUSTON, TX 77057-3731
(713) 952-4088
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N6669
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09659298
—
MS
05
—
280332201
—
TX
05
—
280332202
—
TX
Enumeration date
11/30/2006
Last updated
11/01/2011
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