Individual
CHARLES C NICOLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W 4TH ST, ODESSA, TX 79761-5001
(469) 757-1000
Mailing address
PO BOX 103, ROCKWALL, TX 75087-0103
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E3074
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F4462
MEDICARE
TX
05
—
PENDING
—
TX
Enumeration date
07/14/2006
Last updated
09/25/2007
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